Diaphragmatic Hernia Presenting With Intrathoracic Perforation

Abstract

We have reported the adult patient's intrathoracic incarceration and perforation of the stomach on the left side of the diaphragmatic defect resulting as an empyema case. Besides similar cases are reported, it is not usual even it is the first in literature that without any trauma empyema and herniation secondary spontaneous gastric perforation rarely develops in the Bochdelak foramen of an adult. Male aged 56 was taken to emergency with an acute epigastric pain and hematemesis on the left there was a pleural effusion diagnosis and thoracostomy tube is applied. But the symptoms continued and there can be no expansion in the lung. The left thoracotomy showed the incarseration and perforation of the stomach's fundus herniated in thorax located in the Bochdelak foramen in the diaphragma and posterolateral. The stomach and the diaphragma is successfully repaired by a surgical way. If there is pleural effusion on the left of a patient suffering from epigastric pain and hematemesis diaphragmatic hernia and gastric perforation must be considered in a separating diagnosis. INTRODUCTION Congenital diaphragmatic hernias appear on the left side at the foramen of Bochdelak, and usually in the newborn and early infant period. Tachypnea, cyanosis and respiratory failure are usually seen (1). Adult diaphragmatic hernias are rare and appear usually after a trauma (1,2). We report a left sided diaphragmatic hernia that developed in Bochdelak foramen in a 56 years old male patient. In this case, stomach and a piece of the omentum had herniated into the thorax, and a hemothorax and empyema had developed as a result of the stomach fundus region incarceration and perforation. Thorax X-ray and gastrography with barium is needed for diagnosis, and for appreciating the diaphragma, gastroscopy is the best way, and must be applied if there is any suspicion. PRESENTATION OF THE CASE A 56 years old male patient with a sudden epigastric pain and hematemesis was taken to Akdeniz University Hospital emergency service. The pain in epigastric region was as if a blade was bogging. There had been nausea and bloody vomiting. There was no trauma, no systematic or chronic disease and no misconduct in the previous history. The patient who came with these complaints, was diagnosed with gastritis and he was given a medical therapy. After two days, fewer, pain on the left thorax, and dyspnea were added to his previous complaints. Therefore he was taken to emergency service again. In routine laboratory blood tests, there were no abnormally findings except neutrophilia. His thorax X-ray showed pleural effusion on the left, but no pneumothorax (x-ray.1). Diaphragmatic Hernia Presenting With Intrathoracic Perforation