Other
Incarcerated Diaphragmatic Hernia – Differential Diagnoses
Nado Bukvić
; Department of Pediatric Surgery, University Medical Center Rijeka, Rijeka, Croatia
Ana Bosak Veršić
; Department of Pediatric Surgery, University Medical Center Rijeka, Rijeka, Croatia
Giordano Bačić
; Department of Surgery, University Medical Center Rijeka, Rijeka, Croatia
Nadomir Gusić
; Department of Surgery, General Hospital Pula, Pula, Croatia
Harry Nikolić
; Department of Pediatric Surgery, University Medical Center Rijeka, Rijeka, Croatia
Frane Bukvić
; School of Medicine, University of Zagreb, Zagreb, Croatia
Abstract
The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year old girl who developed the
incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of
the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed
from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses
were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic
and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of
the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a signifi cant shift
of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made
the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous
edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal
colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive
sutures (TiCron) size 2-0 with a previous control and ventilated expansion of the well-developed left lung. In postoperative
course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good
expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax.
Keywords
congenital diaphragmatic hernia; children; incarceration
Hrčak ID:
147436
URI
Publication date:
26.12.2014.
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