Kato N, Iwasaki H, Rino Y, Imada T, Amano T, Kondo J
First Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
Surg Today. 1999;29(4):347-50. doi: 10.1007/BF02483060.
We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.
我们在此报告一例极为罕见的经食管裂孔的胸腔内网膜疝病例。事实上，根据我们对文献的回顾，仅另有八例相关病例被报道，其中大多数在被确认为胸腔内肿物后被误诊为纵隔脂肪瘤。我们在此报告经食管裂孔的胸腔内网膜疝的第九例病例。一名54岁肥胖女性因胸部X线检查异常入院。她没有症状，体格检查和实验室检查数据均在正常范围内。她的胸部X线显示一个大的、边界清晰的肿物，胸部计算机断层扫描显示一个脂肪密度的大纵隔肿物。在诊断为纵隔脂肪瘤的情况下进行了开胸手术，术中发现一个大小为10×7.5×6 cm的包膜下脂肪肿物，经证实为经食管裂孔的网膜疝。没有胃或肠疝入胸腔。在切除网膜肿物和疝囊后修复了食管裂孔。本病例报告旨在表明，每当在下胸部发现脂肪密度的肿物时，应将网膜疝作为一种可能的鉴别诊断加以考虑。
