Eriþkinde konjenital diafram hernisi ile birlikte mide perforasyonu: Ýntratorasik mide perforasyonu

Konjenital diafram hernileri nadirdir ve çoðunlukla neonatal dönemde taný alýr. Bochdalek hernisi olarak da bilinen konjenital diafram defekti genel-likle diafram sol posterolateral bölgesinde embriyolojik dönemde bulunan plöroperitoneal kanalýn persistan olarak kalmasýyla ortaya çýkar. Eriþkinde nadir olarak görülse de konjenital diafram defektiyle birlikte olan intestinal volvulus, strangülasyon veya perforasyon gibi tablolar yüksek morbidite ve mortalite ile seyreder. Bu çalýþmada konjenital diafram hernisi ile birlikte intratorasik mide perforasyonu sebebiyle opere ettiðimiz olgumuzu raporladýk. Hastanýn hastane baþvurusunda atipik bir karýn aðrýsý, belirgin sýrt aðrýsý ve þüpheli respiratuvar þikayetleri bulunmaktaydý. Radyolojik gö-rüntülemelerde diafram hernisine baðlý midenin dilate vaziyette ve dalaðýn sol hemitoraksta bulunduðu görülmekteydi. Hastanýn servise internasyonu sonrasý yatýþýnýn ikinci gününde taþikardi ve hipotansiyon geliþmesi saturasyon düþüklüðü sonrasý yapýlan kontrol görüntülemelerinde sol hemito-raksta; midenin kollabe ve etrafýnda hidropnömotoraks ile uyumlu görünüm olmasý üzerine acil laparotomi kararý verildi. Operasyonda radyolojik bulgularýn da gösterdiði gibi diafram sol posterolateralinde diafram defekti görüldü ve bu defektten mide ve dalak sol hemitoraksa herniye olmuþtu. Mide ve dalak karýn içine redükte edildi. Sol hemitoraks 2000 cc izotonik ile yýkandý, sol tüp torakostomi uygulandý ve diafram onarýldý. Mide ön yüzü primer onarýldý. Ameliyat sonrasý takiplerinde yara yeri enfeksiyonu dýþýnda bir komplikasyon görülmeyen hastanýn toraks tüpü çekildi. Enteral gýdayý tolere eden hasta þifa ile taburcu edildi.

Congenital diaphragmatic hernia with gastric perforation in adult: Intrathoracic gastric perforation

Congenital diaphragmatic hernias are rarely seen and they are usually diagnosed in the neonatal period. Congenital diaphragmatic de-fect, also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Although it is rarely seen in the adults, conditions such as intestinal volvulus, strangulation, or perforation with congenital diaphragm defect progress with high mortality and morbidity. In this study, we reported our case that we operated for intrathoracic gastric perforation with congenital diaphragmatic defect. When the patient admitted to the hospital, he had an atypical abdominal pain, significant back pain, and suspicious respiratory complaints. Radiological imaging showed that the stomach and the spleen were located in the left hemithorax due to diaphragmatic hernia also stomach was very dilated. Tachycardia, hypotension, and low saturation developed on the 2nd day of the patient’s hospitalization. In the control imaging of the patient, in the left hemithorax, stomach was collapsed and the surrounding appearance compatible with hydropneumothorax, after that findings emergency laparotomy was decided. During the operation, as demonstrated by the radiological findings, a diaphragm defect was seen in the left posterolateral region of the diaphragm. The stomach and spleen were herniated to the left hemithorax from this defect. The stomach and spleen were reduced into the abdomen. The left hemithorax was lavaged with 2000 cc isotonic, left tube thoracostomy was applied, and the diaphragm was repaired. The anterior stomach was primarily repaired. In post-operative follow-up, there were no complications other than wound infection and thoracic tube of the patient was removed. The patient who tolerated enteral food was discharged from hospital with full recovery.