Granier Vincent, Coche Emmanuel, Hantson Philippe, Thoma Maximilien
Service des Soins Intensifs, Cliniques Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10 1200, Brussels, Belgium.
Case Rep Med. 2010;2010:296730. doi: 10.1155/2010/296730. Epub 2011 Jan 20.
Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.
引言。博赫达勒克疝是一种先天性膈缺陷，通常在新生儿期被诊断出来，在无症状的成年人中则是偶然发现。成人右侧博赫达勒克疝发生小肠嵌顿的情况极为罕见。病例报告。一名54岁女性因急性呼吸困难、心动过速、低血压和发热入院。五天前，她曾经历过一次弥漫性腹痛。入院时胸部X光检查结果被解读为右侧胸腔积液和气胸伴左侧纵隔移位。胸腔闭式引流引出脓性液体。胸腹部CT检查怀疑通过右侧膈肌缺损发生了肠嵌顿。剖腹手术时，证实为右侧博赫达勒克疝，嵌顿的盲肠完全坏死。进行了回盲部切除术，但患者因延迟性败血症并发症死亡。结论。盲肠胸腔内穿孔是一种罕见情况；由于初始症状具有误导性导致的延迟诊断可能会引发严重并发症并导致预后不良。
