肺葉外肺分画症を伴った成人Bochdalek孔ヘルニアの1例

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  • ADULT BOCHDALEK FORAMEN HERNIA WITH EXTRALOBER SEQUESTRATION-A CASE REPORT-

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A 74-year-old woman was seen at the hospital by an ambulant car because of feeling of heaviness in the chest and dyspnea following flu like symptoms. There was no previous history of trauma, and she had deneyed to undergo any operation for diaphragmatic hernia that was pointed out at the age of 30. After admission, a chest X-ray film revealed a displacement of the mediastinum and a massive gastrointestinal gas image in the left thoracic cavity. A diagnosis of respiratory insufficiency due to diaphragmatic herina was made. CT visualized prolapse of the stomach, small intestine, spleen, and a part of the transverse colon, and atelectasis of the left lower lobe. An operation was electively performed under oblique thoracolaparotomic incision. A diaphragmatic defect was 70×50mm in size and placed dorsolateral to an esophageal hiatus, that was most likely a Bochdalek foramen hernia. The intraperitoneal organs could be easily restored without any adhesion, and no sac was observed. The diaphragm was enhanced by Marlex mesh after it was sutured and closed. When the thoracic cavity was observed, extralobar sequestration was detected just above the diaphragm and it was resected. An abnormal artery 10mm in diameter flowed into the sequestered lung from the aorta, and fine veins running along with the artery were also seen. During postoperative two days, assisted ventilation was performed for hypoventilation due to increased abdominal pressure, but thereafter, the patient recovered her health.

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