Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Case report
Table of Contents - Year : 2016 | Month : April | Volume : 10 | Issue : 4 | Page : PD09 - PD10

Perforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus PD09-PD10

John Mathew Manipadam, George Mathew Sebastian, Venugopal Ambady, Ramesh Hariharan

Dr. John Mathew Manipadam,
Specialist, Department of G.I. Surgery, Lakeshore Hospital and Research Centre,
NH-47 Bypass, Maradu, Nettoor PO, Kochi-682040, India.

Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax.