Abstract
A 74-year-old female, who had been treated at the out-patient-clinic after total gastrectomy for a gastric cancer 8 years before, was admitted to the hospital with a suspicion of ileus, because left upper abdominal pain developed without any inductions. A chest X-ray film taken 3 days after admission showed abnormal gas shadow with air fluid level (niveau) in the left pleural cavity. Colonography revealed an obstruction of the colon at the splenic curvature and intestinal juice like fluid was discharged from left thoracic drainage. A diagnosis of perforation of the colon strangulated to diaphlagmatic herniation was made. Under thoraco-laparotomy, the herniaiton was recognized in the site of Foramen Bochdalek, so direct closure of the hernia opening and resection of the necrotic colon were carried out. There was no hernia sac, and the size of opening 1.2cm in diameter was the smallest in the literature reported previously.
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