Ekanayake Emnp, Fernando S A, Durairajah P L, Jayasundara Jasb
Base Hospital , Puttalam , Sri Lanka.
District General Hospital , Mannar , Sri Lanka.
Ann R Coll Surg Engl. 2017 Jul;99(6):e159-e161. doi: 10.1308/rcsann.2017.0065.
Bochdalek hernias occur as a result of congenital fusion failure of the posterolateral muscular portion of the diaphragm derived from the embryonic pleuroperitoneal membrane. The vast majority of symptomatic Bochdalek hernias are diagnosed during the neonatal period. Congenital diaphragmatic hernias showing symptoms in adulthood are rare. We report the case of a 28-year-old man who presented with subacute bowel obstruction, later diagnosed to have a left-sided incarcerated Bochdalek hernia containing an ischaemic splenic flexure and the distal transverse colon. During laparotomy, he underwent primary repair of the diaphragmatic defect and an extended right hemicolectomy with ileocolic anastomosis. The patient made a good recovery and is well at three months following surgery. This case highlights the need for surgeons to be vigilant about rare types of congenital internal hernias as they may become symptomatic later in life.
波氏疝是由于源自胚胎胸膜腹膜膜的膈肌后外侧肌肉部分先天性融合失败所致。绝大多数有症状的波氏疝在新生儿期被诊断出来。成年后出现症状的先天性膈疝很少见。我们报告一例28岁男性病例,该患者表现为亚急性肠梗阻,后来被诊断为左侧嵌顿性波氏疝,疝内容物为缺血的脾曲和横结肠远端。在剖腹手术中,他接受了膈肌缺损的一期修复以及扩大的右半结肠切除术并进行回结肠吻合术。患者恢复良好,术后三个月情况良好。该病例强调外科医生需要警惕罕见类型的先天性内疝,因为它们可能在生命后期出现症状。