Open AccessPerforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus
Author(s) -
Manipadam Jm,
Sebastian Gm,
Ambady,
H. Ramesh
Publication year - 2016
Publication title -
journal of clinical and diagnostic research
Language(s) - English
Resource type - Journals
eISSN - 2249-782X
pISSN - 0973-709X
DOI - 10.7860/jcdr/2016/18032.7552
Subject(s) - medicine , surgery , laparotomy , pneumothorax , gangrene , perforation , diaphragmatic hernia , volvulus , diaphragm (acoustics) , gastric volvulus , stomach , pleural cavity , thoracotomy , bochdalek hernia , hernia , diaphragmatic breathing , congenital diaphragmatic hernia , gastroenterology , pregnancy , fetus , materials science , physics , genetics , alternative medicine , pathology , biology , acoustics , loudspeaker , punching , metallurgy
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.