A Case of Bochdalek Hernia in an Adult with Organoaxial Volvulus of the Stomach

Takanori Yoshida, Takao Saito, Shinichi Okuzono, Michio Kobayashi, Junichiro Cho*

The First Department of Surgery, Oita Medical University
*Cho Surgical Hospital

We report a rare case of Bochdalek hernia in an adult with organoaxial volvulus of the stomach. A 27-year-old Japanese man experienced a sudden episode of severe abdominal pain and vomiting. Radiologic examination of the chest showed left-sided basal atelectasis and an indistinctly outlined left diaphragmatic dome. Upper gastrointestinal series revealed a shift toward the right of the greater curvature of the stomach and displacement of the small bowels into the left thoracic cavity. Inferior phrenic arteriography and superior mesenteric arteriography were particularly helpful in differentiating diaphragmatic hernia from eventration of the diaphragma. An upper abdominal midline incision was performed. The left flexure of the colon, jejunum, ileum and greater omentum were displaced into the left thoracic cavity. An organoaxial volvulus of the stomach was confirmed. After reduction of the herniated viscera, a defect measuring 6 by 6 cm, in the posterolateral part of the diaphragma, was closed with double interrupted silk sutures. The gastric volvulus decreased spontaneously. Three months later, he was asymptomatic and his chest roentgenogram was normal.

Key words
Bochdalek hernia in an adult, secondary organoaxial volvulus of the stomach

Reprint requests
Takanori Yoshida The First Department of Surgery, Oita Medical University
1-1 Idaigaoka, Hasama-machi, Oita, 879-55 JAPAN

Accepted
December 9, 1992

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