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Small bowel strangulation due to peritoneopericardial diaphragmatic hernia
1Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea. heartljh@yumail.ac.kr.
Journal of Cardiothoracic Surgery
|April 4, 2014
Summary
A rare case of peritoneopericardial diaphragmatic hernia with small bowel strangulation was diagnosed in a 75-year-old man presenting with abdominal pain. Surgical repair was successful, highlighting the importance of considering this rare condition.
Area of Science:
- Gastroenterology
- Cardiology
- Thoracic Surgery
Background:
- Peritoneopericardial diaphragmatic hernia (PPDH) is an extremely rare congenital anomaly.
- It involves the herniation of abdominal contents into the thoracic cavity through a defect in the diaphragm, specifically the pleuropericardial membrane.
- PPDH is often asymptomatic in adults, with diagnosis frequently occurring incidentally or during investigations for unrelated symptoms.
Observation:
- A 75-year-old Korean male presented with acute cramping abdominal pain.
- Initial chest X-ray revealed an abnormal air shadow above the diaphragm.
- Computed tomography (CT) confirmed the presence of abdominal viscera within the pericardium, indicative of a diaphragmatic hernia.
Findings:
- Surgical exploration confirmed a diagnosis of peritoneopericardial diaphragmatic hernia.
- The patient also had evidence of small bowel strangulation, a serious complication.
- The surgical intervention involved the repair of the diaphragmatic defect and management of the strangulated bowel.
Implications:
- This case underscores the rarity of PPDH in the adult population.
- It emphasizes the diagnostic challenge posed by PPDH, especially when presenting with abdominal symptoms.
- Early surgical intervention is crucial for managing complications like bowel strangulation in PPDH.
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