Karanikas I D, Dendrinos S S, Liakakos T D, Koufopoulos I P
2nd Surgical Department, General Hospital, Athens, Greece.
J Cardiovasc Surg (Torino). 1994 Dec;35(6):555-8.
The literature on incarceration in Bochdalek hernias in adults is rather limited. Our purpose is to present two cases of this lesion that were treated surgically in the past ten years. The first patient, a 32 year old female was admitted in shock with an 8h history of left chest pain and dyspnoea. Chest X-ray showed a pleural effusion in the left hemithorax. Chest tube drainage revealed gastric fluid. We operated on her immediately, through a left thoracotomy, and found rupture of the stomach into the left pleural cavity. Strangulation of the fundus of the stomach due to congenital diaphragmatic hernia, Bochdalek's type, was found to be the cause of the rupture. We performed resection of the gangrenous segment of the stomach with primary closure. The second patient a 48 year old man was admitted with symptoms of large bowel obstruction. Per os gastrographin study showed the splenic flexure herniated into the left hemithorax. At the operation, through a paramedian left incision, the herniated large bowel was reduced back into the abdomen. In both cases the defect of the left hemidiaphragm was sutured with interrupted silk sutures. Both patients had an uneventful postoperative course. The diagnosis of Bochdalek hernia in the adult is usually made in case of complications, and that demands an immediate surgical repair.
关于成人Bochdalek疝嵌顿的文献相当有限。我们的目的是介绍过去十年中通过手术治疗的两例该病变病例。首例患者为一名32岁女性，因左胸痛和呼吸困难8小时入院，处于休克状态。胸部X线显示左半侧胸腔有胸腔积液。胸腔闭式引流引出胃液。我们立即通过左胸切开术对其进行手术，发现胃破裂进入左胸腔。发现先天性膈疝（Bochdalek型）导致胃底绞窄是破裂的原因。我们对胃坏死段进行了切除并一期缝合。第二例患者为一名48岁男性，因大肠梗阻症状入院。口服泛影葡胺造影显示脾曲疝入左胸腔。手术时，通过左旁正中切口，将疝出的大肠还纳回腹腔。在两例病例中，左半膈肌缺损均用间断丝线缝合。两名患者术后病程均顺利。成人Bochdalek疝的诊断通常在出现并发症时做出，这需要立即进行手术修复。
