Abstract
An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.
Highlights
Bochdalek hernia is one of the most common congenital diaphragmatic hernias, and most cases are diagnosed in the neonatal period with clinical features related to the respiratory system [1]
Symptoms are rare in adults, and it is usually incidentally discovered in patients with gastrointestinal symptoms [2]
Abdominal X-ray showed small intestinal gas and the computed tomography showed the transverse colon located above the right lobe of the liver, known as Chilaiditi’s sign (Fig. 1a)
Summary
Bochdalek hernia is one of the most common congenital diaphragmatic hernias, and most cases are diagnosed in the neonatal period with clinical features related to the respiratory system [1]. Chilaiditi’s sign is a rare radiographic finding of subdiaphragmatic radiolucency due to interposition of the intestine between the liver and the diaphragm, and when it is associated with digestive symptoms, it is termed Chilaiditi’s syndrome [3, 4] In both Bochdalek hernia and Chilaiditi’s Syndrome, if the symptoms progress to bowel obstruction or ischemia, emergent surgical treatment is needed. A small part of the liver and intestinal fat tissue had been seen in the bottom of the right thoracic cavity, probably due to the congenital hernia (Fig. 1b, c) She was diagnosed as having ileus due to Chilaiditi’s syndrome and was treated with decompression therapy by a nasoenteric tube.
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