Perforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus
Published: April 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/.7552
John Mathew Manipadam, George Mathew Sebastian, Venugopal Ambady, Ramesh Hariharan
1. Specialist, Department of G.I. Surgery, Lakeshore Hospital and Research Centre, Maradu, Nettoor PO, Kochi, India.
2. Resident, Department of G.I. Surgery, Lakeshore Hospital and Research Centre, Maradu, Nettoor PO, Kochi, India.
3. Senior Consultant, Department of G.I. Surgery, Lakeshore Hospital and Research Centre, Maradu, Nettoor PO, Kochi, India.
4. Professor and Head, Department of G.I. Surgery, Lakeshore Hospital and Research Centre, Maradu, Nettoor PO, Kochi, India.
Correspondence
Dr. John Mathew Manipadam,
Specialist, Department of G.I. Surgery, Lakeshore Hospital and Research Centre,
NH-47 Bypass, Maradu, Nettoor PO, Kochi-682040, India.
E-mail: jm_manipadam@yahoo.com
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.
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