Biswas Saptarshi, Gogna Shekhar, Patel Prem
Department of Trauma and Acute Care Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
Department of General Surgery, Westchester University Medical Center, Valhalla, NY, USA.
Case Rep Surg. 2017;2017:8412927. doi: 10.1155/2017/8412927. Epub 2017 Oct 10.
Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula.
IV型食管旁疝（PEH）非常罕见，其特征是除胃以外的腹腔脏器疝入胸腔。我们描述了一例90岁男性患者，他因过去几小时出现上腹部疼痛且逐渐加重而到我院急诊科就诊。入院次日，他的疼痛加剧。胸部X线检查显示胸腔内有肠气泡；急诊剖腹探查发现IV型PEH，仅空肠通过食管裂孔缺损疝入纵隔，肠系膜侧有穿孔憩室。文献中有少数小肠疝入胸腔的病例报道。我们的患者是一例罕见的被诊断为IV型PEH且空肠伴有穿孔憩室疝入的病例。
