Adult Parahiatal Diaphragmatic Hernia Associated with Organoaxial Gastric Volvulus

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  • 長軸性胃軸捻を伴った成人横隔膜傍裂孔ヘルニアの1例
  • 症例 長軸性胃軸捻を伴った成人横隔膜傍裂孔ヘルニアの1例
  • ショウレイ チョウジクセイ イジクネン オ トモナッタ セイジン オウカクマク ボウレツコウ ヘルニア ノ 1レイ

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Abstract

A 61-year-old woman with an asymptomatic diaphragmatic hernia for a decade and no history of injury was referred to our hospital for vomiting and hematemesis. Endoscopy revealed stomach protrusion into the thoracic cavity. An upper gastrointestinal series showed an organoaxial gastric volvulus. Multidetector row computed tomography demonstrated migration of the stomach and part of the omentum into the left thoracic cavity. With the preoperative appearance of a Bochdalek hernia, we performed a laparotomy for hernia repair, with consideration of adhesions between the hernia sac and organs as well as compromised respiratory function. Intraoperative findings disclosed a typical parahiatal hernia with a diaphragmatic defect, 1 cm lateral to the left crus of the diaphragm. After restoring normal anatomy by dissecting the adhesions between the sac and involved organs, the diaphragmatic defect was then sutured. The patient resumed her usual daily life, without recurrence. We report this case because parahiatal hernia is very rare (0.2-3.3% of diaphragmatic hernias). To our knowledge, only 10 cases have been reported in the literature in Japan, and cases associated with organoaxial gastric volvulus are particularly rare.

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