Abstract
A healthy 52-year-old male presented himself in the emergency department with a 2-week history of epigastralgia. During physical examination, the patient suddenly complained of severe dyspnea and then shock ensued. Thoracoabdominal CT showed a strangulated ileus and pneumothorax in the left thoracic cavity. Dexter deviation of the mediastinal organs and insufficiency of right lung expansion were observed, and an emergency operation was performed. The stomach, small intestine, colon, greater omentum, and spleen were herniated to the left thoracic cavity through the postero-lateral diaphragmatic defect. Intraoperative findings indicated a diagnosis of congenital Bochdalek hernia. The inflammatory mass in the meso-appendix originating from the appendix was strongly adherent to the colon. The lobes of the left lung were the size of fist because of a pulmonary hypoplasia. Ileocaecal resection, splenectomy, and resection of the extensive necrotic small intestine were performed. The hernial defect was repaired in two overlapping layers with interrupted mattress sutures after restoration of the herniated organs via laparotomy. In emergency cases with multiple herniated organs and whose cardiorespiratory function is unstable, surgery with rapid and safe manipulation should be recommended through simultaneous thoracotomy and laparotomy.
