PDF(Pubmed)
Abstract：
A Bochdalek hernia is a rare congenital diaphragmatic hernia often diagnosed in infancy and classically occurring on the left side. We report a case of a 78-year-old female who presented with a right-sided posterolateral diaphragmatic hernia containing multiple loops of bowel with evidence of ischemia as well as a type 4 paraesophageal hernia. The stomach was rotated on the organoaxial plane, and the duodenum was within the mediastinum. The patient was taken emergently for an exploratory laparotomy. A posterolateral hernia defect containing 50 cm of strangulated small bowel was identified and resected, a primary stapled enteroenterostomy was performed and the hernia defect was repaired primarily. The stomach was reduced, a primary crura repair was performed, and gastropexy was performed with a gastrojejunostomy tube. The patient was transferred to the intensive care unit, and subsequently extubated, enteral feeds were initiated, and had anticipated discharge to a skilled nursing facility. This case highlights an uncommon atraumatic presentation of an adult with a congenital diaphragmatic hernia. Its rarity is further denoted due to its right-sided laterality and strangulated small bowel as the usual herniated abdominal organs are the liver or colon.
摘要：
Bochdalek疝气是一种罕见的先天性膈疝，通常在婴儿期被诊断为左侧。我们报告了一例78岁的女性，该女性患有右侧后外侧膈疝，其中包含多个肠环，有缺血迹象以及4型食管旁疝。胃在有机轴平面上旋转，十二指肠位于纵隔内.患者被紧急采取剖腹探查术。发现并切除了包含50厘米绞窄小肠的后外侧疝缺损，进行了原发性吻合器肠肠造口术，并首先修复了疝缺损。胃减少了，进行了一次crura修复，用胃空肠造口管进行胃切除术。病人被转移到重症监护室,随后拔管，开始肠内喂养，并预计将出院到熟练的护理机构。此病例突显了成人先天性膈疝的罕见无创伤表现。由于其右侧偏侧和绞窄的小肠，其稀有性进一步表示为通常的腹部突出器官是肝脏或结肠。
