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腹腔脏器移位至胸腔:一例罕见的成人波氏孔疝病例

Displacement of Abdominal Organs Into the Thoracic Cavity: A Rare Case of Adult Bochdalek Hernia.

作者信息

Hu Sien, Yang Xiaohui, Wu Yulian

机构信息

Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN.

Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, CHN.

出版信息

Cureus. 2024 Mar 26;16(3):e56950. doi: 10.7759/cureus.56950. eCollection 2024 Mar.

Abstract

Congenital diaphragmatic hernias are primarily found in infants and have a high mortality rate due to neonatal respiratory distress. The most common type of congenital diaphragmatic hernia is Bochdalek hernia, which occurs in the posterolateral diaphragm, with the left side being the most commonly affected. However, congenital diaphragmatic hernias are extremely rare in adults and are often misdiagnosed due to their subtle symptoms. Therefore, we suggest that a contrast-enhanced CT scan should be used for early screening and diagnosis in all patients with sudden severe pain or recurrent ambiguous symptoms in the chest and abdomen. This case report presents a rare occurrence of Bochdalek hernia in an adult male. The patient experienced nonspecific abdominal symptoms after eating. The hernia resulted in the displacement of the left kidney, the transverse colon of the splenic flexure, and most of the stomach into the thoracic cavity. This displacement led to atelectasis of the left lung, which reached three-fifths of its capacity. The patient underwent successful treatment using a combination of laparoscopy and open surgery. Follow-up CT scans conducted two weeks, three months, and one year later revealed a stable condition with no complications.

摘要

先天性膈疝主要见于婴儿,由于新生儿呼吸窘迫,其死亡率很高。最常见的先天性膈疝类型是博赫dalek疝,发生在膈肌后外侧,左侧最常受累。然而,先天性膈疝在成人中极为罕见,且由于症状不明显常被误诊。因此,我们建议对所有突发严重胸痛或反复出现腹部模糊症状的患者进行增强CT扫描以进行早期筛查和诊断。本病例报告呈现了一名成年男性罕见的博赫dalek疝病例。患者进食后出现非特异性腹部症状。该疝导致左肾、脾曲横结肠和大部分胃移位至胸腔。这种移位导致左肺肺不张,肺不张程度达其容量的五分之三。患者通过腹腔镜手术和开放手术联合治疗获得成功。术后两周、三个月和一年进行的CT随访扫描显示病情稳定,无并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21cc/10965112/fbeaa9c7efd2/cureus-0016-00000056950-i01.jpg

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