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báo cáo khoa học: "Massive right-sided Bochdalek hernia with two unusual findings: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài:Massive right-sided Bochdalek hernia with two unusual findings: a case report | Deb Journal of Medical Case Reports 2011 5 519 http www.jmedicalcasereports.eom content 5 1 519 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Massive right-sided Bochdalek hernia with two unusual findings a case report Subrato J Deb Abstract Introduction In this report the case of an adult patient with a massive right-sided Bochdalek hernia with multiple displaced abdominal organs including the liver and gallbladder is described. This patient presented with acute cholecystitis of the malpositioned gallbladder. During surgery nodular regenerative hyperplasia of the liver was also found. To the best of this author s knowledge these two entities have never been reported in association with this rare condition. Case presentation A 54-year-old Caucasian man presented with nausea and epigastric pain. He had a known history of right-sided Bochdalek hernia which was being managed expectantly. A computerized tomogram revealed the massive hernia with displaced stomach liver intestine and omentum into his right thorax. It was believed that our patient had bowel incarceration and he was therefore taken to surgery where acute cholecystitis and a macronodular liver was identified. A thoracoabdominal approach was used to remove his gallbladder reduce the herniated viscera and reconstruct his diaphragm. A liver biopsy identified nodular regenerative hyperplasia of the ectopic liver. There were no postoperative complications and at 12 month follow-up our patient continues to do well. Conclusion This case report describes two unusual findings associated with a congenital Bochdalek diaphragmatic hernia that have never been reported. In addition unique caveats to the surgical management of this complex rare condition are discussed. Introduction Diaphragmatic hernias of Bochdalek are rare congenital defects that occur along the posterolateral aspect of the diaphragm. In a recent review the incidence of adult Bochdalek hernias was noted at 0.17 based on 13 138 abdominal .