İnsidental Olarak Saptanan Bochdalek Hernilerinin Çok Kesitli Bilgisayarlı Tomografi ile Değerlendirilmesi

Amaç: Erişkinlerde çok kesitli bilgisayarlı tomografi ile insidental olarak saptanan asemptomatik Bochdalek hernisi sıklığını araştırmak, obezite ve diyafragma krus kalınlığı ile Bochdalek hernisi arasındaki ilişkiyi değerlendirmektir.Gereç ve Yöntemler: 870 adet toraks ve abdomen çok kesitli bilgisayarlı tomografi tetkiki retrospektif olarak tarandı. Bochdalek hernisi varlığı, prevalansı ve herni lokalizasyonu araştırıldı. Bochdalek hernisi saptanan hastalarda aksiyal kesitlerde, defekt komşuluğundan diyafragma krus kalınlığı ve umbilikus hizasında sağ paramedyan alandan ciltaltı yağ dokusu kalınlığı ölçüldü. Ayrıca defektin boyutu ve herni kesesinin hacmi de aynı görüntülerde hesaplandı. Daha sonra defekt boyutları ve herni kesesinin hacmi ile diyafragma krus kalınlığı ve ciltaltı yağ dokusu kalınlığı arasında ilişki olup olmadığı araştırıldı.Bulgular: 30 hastada toplam 34 adet (%3,9) Bochdalek hernisi saptandı. Bochdalek hernisi 13 (%43,3) hastada sağda, 13 (%43,3) hastada solda, 4 (%13,3) hastada ise bilateraldi. Herni kesesinin içeriği 32 (%94) hastada omental yağ dokusundan, 1 (%3) hastada karaciğerden, 1 (%3) hastada ise kolondan oluşmaktaydı. Herniye segment hacmi kadın hastalarda 153 [84-361] µl, erkek hastalarda 339 [202-432,5] µl hesaplanmış olup, bu değer kadın hastalarda istatistiksel açıdan anlamlı şekilde daha düşüktü (p=0,032). Diyafragma krus kalınlığı ve ciltaltı yağ dokusu ile hem herniye segment hacmi hem de defekt boyutu arasında anlamlı bir ilişki izlenmedi (p>0,05). Tartışma ve Sonuç: Çalışmamızda çok kesitli bilgisayarlı tomografi ile saptanan, insidental Bochdalek hernisi sıklığı %3,9'dur ve herniye segment hacmi kadınlarda erkeklere göre daha düşük bulunmuştur. Obezite diğer intraabdominal hernilerin patogenezinde önemli bir rol oynamasına rağmen, asemptomatik insidental Bochdalek hernisinde defekt genişliği ile obezite ve diyafragma krus kalınlığı arasında anlamlı bir ilişki saptanmamıştır

Evaluation of Incidentally Detected Bochdalek Hernia by Multislice Computed Tomography

Aim: In this study, we aimed to investigate the adult incidence of asymptomatic Bochdalek hernia detected incidentally by multislice computed tomography and the relation between Bochdalek hernia and obesity as well as diaphragmatic crus thickness.Materials and Methods: Eight hundred and seventy multislice computed tomography images of the thorax and abdomen were screened retrospectively to investigate Bochdalek hernia presence, prevalence, and localization. In the patients with Bochdalek hernia, diaphragmatic crus thickness at defect border and subcutaneous fat tissue thickness in the right paramedian area at umbilicus level were measured in the axial sections. Defect size and hernia sac volume were also calculated on the same images. Then, possible correlation of defect size and hernia sac volume with diaphragmatic crus thickness and subcutaneous fat tissue was investigated.Results: Thirty-four Bochdalek hernia (3.9%) sacs were detected in 30 patients. Bochdalek hernia was on the left side in 13 patients (43.3%), on the right side in 13 patients (43.3%), and bilateral in 4 patients (13.3%). The hernia sac consisted of omental fat tissue in 32 patients (94%), of liver in 1 patient (3%), and of colon in 1 patient (3%). The segmental volume of hernia was 153 [84–361] µl in female patients and 339 [202–432.5] µl in male patients, and the difference was statistically significant (p=0.032). Neither segmental volume of hernia nor defect size was found to be correlated with diaphragmatic crus thickness or subcutaneous fat tissue (p>0.05).Discussion and Conclusion: In our study, incidence of Bochdalek hernia detected by multislice computed tomography is 3.9% and segmental volume of hernia was found to be significantly lower in females compared to males. Although obesity plays an important role in pathogenesis of intraabdominal hernia, no significant correlation was detected between defect size of asymptomatic incidental Bochdalek hernia and obesity as well as diaphragmatic crus thickness

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