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[Incarcerated diaphragmatic hernia presenting as colonic obstruction]
Y Moses1, S Sapoznicov, Y Manoskin
1Dept. of General and Vascular Surgery, Barzilai Medical Center, Ashkelon.
Insights
Rare adult diaphragmatic hernias, excluding hiatal hernias, often present with gastrointestinal complications like colonic incarceration. Increased awareness is key for timely diagnosis and treatment of these thoraco-abdominal emergencies.
Area of Science:
- General Surgery
- Thoracic Surgery
- Gastroenterology
Background:
- Diaphragmatic hernias are rare in adults, unlike common hiatal hernias.
- Congenital diaphragmatic hernias typically present in infants with severe respiratory distress.
Observation:
- This study details three adult male cases of non-hiatal diaphragmatic hernias.
- Two cases involved colonic incarceration with strangulation; one was an incidental finding during trauma evaluation.
Findings:
- Adult diaphragmatic hernias predominantly manifest with gastrointestinal complications, contrasting with infant presentations.
- Clinical presentation in adults includes incarcerated or strangulated colon within the hernia.
Implications:
- High awareness of adult diaphragmatic hernias, potentially recurrent from perinatal repair, is crucial for effective treatment.
- Management requires a combined thoraco-abdominal approach, often involving simultaneous laparotomy, thoracotomy, and stoma formation.
Abstract:
Diaphragmatic hernias in adults that are not categorized as hiatal hernias are rare. Hernias of the diaphragm itself appear in the perinatal age group and are defined as congenital hernias, presenting with severe respiratory distress and requiring immediate repair. There are a few asymptomatic post-partum cases in young children or adults. We present 3 cases of diaphragmatic hernia in men, aged 19, 20 and 74, respectively. 2 were admitted because of colonic incarceration with strangulation in the hernial sac. In the other case there was an incidental finding of incarcerated colon in a diaphragmatic hernia discovered in a patient who initially presented with unrelated thoraco-abdominal trauma. Contrary to the dominant clinical presentation as infant-respiratory distress, the predominant findings in adults are gastrointestinal complications. We believe successful treatment is more likely when there is a high level of awareness of the possibility of this kind of hernia in the adult, which can be a recurrence after perinatal hernia repair. It is essential to recognize that this is a combined thoraco-abdominal problem since it is often necessary to perform simultaneous laparotomy, thoracotomy and stoma formation.