Abstract
A 72-year-old woman was seen at the hospital because of chest pain on inspiration.
There was no abnormality in the blood or abdominal ultrasonography. Four days later, left anterior chest pain appeared again, she visited the Emergency Center. Chest X-ray showed left pleural effusion and left diaphragm elevation as well as an increased inflammatory response. She had increased pain and vital shock on the day after admission, and we diagnosed gastric volvulus and diaphragmatic hernia incarcerated by a thoracoabdominal computed tomography (CT) and performed emergency surgery. During the emergency celiotomy, we found that the stomach, spleen and transverse colon had herniated to the left thoracic cavity through the left Bochdalek foramen, and a gastric perforation had penetrated the bottom and the lung. Abdominal chest drainage, total gastrectomy, diaphragm repair, and enterostomy were performed.
She was treated by a multidisciplinary treatment including artificial respiration management and endotoxin adsorption therapy and discharged about 2 months after surgery.
