Incarcerated Small Bowel inside A Slide Hernia Composed of Colon Wall Triggered by Left Bochdalek Hernia in Adult:An Extremely Rare Etiology of Acute Intestinal Volvulus

Abstract

Acute abdomen triggered by acute bowel obstruction is common in clinical practice, which may be caused by various reasons such as inflammation, tumors, intussusception and incarcerated hernia,etc. Here by, we describe a young man who was a heavy phsical worker presented with an abdominal pain and a sudden onset for nearly a day duration, accompanied with frequent nausea and vomiting, which could be partially relieved on his standing position. Empty feeling with mild tenderness was palpable on his right lower quadrant abdomen and abnormal bowel sounds were heard in his left chest cavity. Acute abdominal intestinal incarcerated obstruction was demonstrated on computed tomography (CT) of the abdomen. Urgent laparascopic exploration unveiled a Bochdalek hernia with a 3 cm defect in diameter that was subsequently closed by continual suture after the incarcerated reduced. The key to success is early identification of characterized features on images such as chest X-ray and abdominal CT, combined with the abdominal pain attack relieved by standing or semi-recombent position. In addition, the defect of Bodalek hernia is recommended to take a continual suture with a slowly absorbed barbed suture so as to strenthen the firmeness of the diaphragm.