Z Gastroenterol 2011; 49(8): 986-988
DOI: 10.1055/s-0029-1245982
Kasuistik

© Georg Thieme Verlag KG Stuttgart · New York

Large-Bowel Obstruction as a Late Sequela of Retrosternal Diaphragmatic Hernia

Ileus und diaphragmatischer LeistenbruchB. Kaptanoglu1 , M. Yildiz1 , A. Taş2 , S. Köklü2 , R. Pekcici3 , A. S. Karakayali1
  • 1Department of 5th General Surgery, Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey
  • 2Department of Gastroenterology, Ankara Education and Research Hospital, Ulucanlar, Ankara, Turkey
  • 3Department of 1st General Surgery, Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey
Weitere Informationen

Publikationsverlauf

manuscript received: 27.10.2010

manuscript accepted: 17.12.2010

Publikationsdatum:
02. August 2011 (online)

Zusammenfassung

Ein 37-jähriger Mann, der vor 16 Jahren aus der Höhe gestürzt war, präsentierte sich mit einem akuten Abdomen. Bei der Untersuchung wurde eine intestinale Obstruktion festgestellt, die durch eine Zwerchfellhernie verursacht worden war. Der Patient hatte infolge der linken Zwerchfellhernie ein inkarzeriertes Omentum und eine Richter-Hernie des Querkolons und infolgedessen einen Dickdarmileus. Nach Resektion des strangulierten Omentums und Rückverlagerung des Dickdarms in das Abdomen wurde die Hernie über einen abdominal-transthorakalen Zugang chirurgisch korrigiert. Das Auftreten eines Ileus als relativ seltene Spätfolge eines linksseitigen Enterothorax macht diesen Fall beachtenswert und unterstreicht die Notwendigkeit einer frühzeitigen Operation, um Spätkomplikationen zu vermeiden.

Abstract

A 37-year-old man with a past history of a fall from height 16 years previously was admitted with acute abdomen. Investigations revealed intestinal obstruction caused by a diaphragmatic hernia. He had an incarcerated omentum and Richter’s hernia of the transverse colon secondary to left diaphragmatic hernia leading to colonic ileus. Following resection of the strangulated omentum and reduction of the colon intraabdominally, a surgical repair of the hernia was performed using an abdominal and transthoracic approach. The relatively rare late complication of a left-sided enterothorax with ileus makes this a remarkable case and underlines the need for early surgery to avoid late complications.

References

  • 1 Paris F, Tarazona V, Casillas M et al. Hernia of Morgagni.  Thorax. 1973;  28 631-636
  • 2 Boyd D P. Diaphragmatic hernia through the foramen of Morgagni.  Surg Clin North Am. 1961;  41 839-846
  • 3 Kimmelstiel F M, Holgersen L O, Hilfer C. Retrosternal (Morgagni) hernia with small bowel obstruction secondary to a Richter’s incarceration.  J Pediatr Surg. 1987;  22 998-1000
  • 4 Federico J A, Ponn R B. Foramen of Morgagni hernia. In Shields T W, Lo Cicero III J, Ponn R B, eds General Thoracic Surgery, 5th ed.. Philadelphia: Lippincott Williams and Wilkins; 2000: 647-660
  • 5 Harris G J, Soper R T, Kimura K K. Foramen of Morgagni hernia in identical twins: is this an inheritable defect?.  J Pediatr Surg. 1993;  28 177-178
  • 6 Kurkcuoglu I C, Eroglu A, Karaoglanoglu N et al. Diagnosis and surgical treatment of Morgagni hernia: report of three cases.  Surg Today. 2003;  33 525-528
  • 7 Feliciano D V, Cruse P A, Mattox K L et al. Delayed diagnosis of injuries to the diaphragm after penetrating wounds.  J Trauma. 1988;  28 1135-1144
  • 8 Degiannis E, Levy R D, Sofianos C et al. Diaphragmatic herniation after penetrating trauma.  Br J Surg. 1996;  83 88-91
  • 9 Sola J E, Mattei P, Pegoli Jr W et al. Rupture of the right diaphragm following blunt trauma in an infant: case report.  J Trauma. 1994;  36 417-420
  • 10 Brooks J W. Traumatic diaphragmatic hernia. In Nyhus L, Baker R J, (ed.) Mastery of Surgery, ed 2.. Boston: Little, Brown and Company; 1992: 415-419
  • 11 Ivatury R R, Simon R J, Weksler B et al. Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury.  J Trauma. 1992;  33 101-108
  • 12 Jackson A M, Ferreira A A. Thoracoscopy as an aid to the diagnosis of diaphragmatic injury in penetrating wounds of the left lower chest: a preliminary report.  Injury. 1976;  7 213-217
  • 13 Shea L, Graham A D, Fletcher J C et al. Diaphragmatic injury: a method for early diagnosis.  J Trauma. 1982;  22 539-543
  • 14 Aronoff R J, Reynolds J, Thal E R. Evaluation of diaphragmatic injuries.  Am J Surg. 1982;  144 571-575
  • 15 Voeller G R, Reisser J R, Fabian T C et al. Blunt diaphragm injuries. A five-year experience.  Am Surg. 1990;  56 28-31
  • 16 Gaissie G, Young L W, Oh K S. Late-onset Bochdalek’s hernia with obstruction: radiographic spectrum of presentation.  Clin Radiol. 1983;  34 267-270
  • 17 Barut I, Tarhan O R, Cerci C et al. Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient.  J Thorac Imaging. 2005;  20 220-222
  • 18 Pokorny W J, McGill C W, Harberg F J. Morgagni hernias during infancy: presentation and associated anomalies.  J Pediatr Surg. 1984;  19 394-397
  • 19 Kilic D, Nadir A, Döner E et al. Transthoracic approach in surgical management of Morgagni hernia.  Eur J Cardiothorac Surg. 2001;  20 1016-1019
  • 20 Taskin M, Zengin K, Unal E et al. Laparoscopic repair of congenital diaphragmatic hernias.  Surg Endosc. 2002;  16 869

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