Abstract

 

Adult type diaphragm hernias are seen usually in penetrating injuries. But herniation may be possible through the congenital diaphragmatic defects in the adults which rarely occur.

A 34-year-old male patient was admitted to the hospital because of the pathologic appearance in his control chest radiography. In his physical examination there was no abnormal finding except decreased breath sounds in the lower part of left hemithorax. It was detected that two-thirds of the left hemithorax was filled with the intestine except stomach and left colon in chest x-ray, CT and graphies with barium. There was no mediastinal shift. Abdominal solid viscera were not herniated. Posterolateral thoracotomy was performed. It was detected that there was a 8 cm-diaphragmatic defect in the posterolateral portion of the diaphragm and intestinal viscera was herniated through the defect to the thorax. There was no peritoneal sac. We could hardly manage the reduction of viscera to the abdomen only after median laparatomy was performed. No complication was determined.

Although, thoracotomy is the initial approach for the chronic diaphragmatic hernia, laparotomy should be added to the procedure because of the difficulties in reduction of massive viscera herniation to the small abdomen and presence of malrotation.

Key Words: Hernia, Surgical treatment, Diaphragm, Congenital, Bochdalek