Salih TOPÇU, Erdem OKAY, Şerife Tuba LİMAN, Ali ÖZERDEM, Emre ÖZKER, Ercüment ÇİFTÇİ

Symptomless massive herniation: Giant adult bochdalek hernia+

Eri kin tipi diyafram hernileri sıklıkla travmatik olup delici kesici alet yaralanmalarından sonra görülmektedir. Ancakçok nadir de olsa diyafragmatik konjenital defektlerden ileri ya larda herniasyon olabilir.34 ya ında erkek hasta kontrol akci er grafisinde patoloji saptanması üzerine hastanemize ba vurdu. Hastanın fizikmuayenesinde sol alt zonda solunum seslerinde azalma dı ında pozitif bulgu tespit edilmedi. Hastanın akci er grafisi,toraks tomografisi ve baryumlu tetkikleri sonucunda sol hemitoraksın 2/3 alt kısmını mide ve sol kolon haricindetüm intestinal sistemin doldurdu u görüldü. Mediastinal shift geli memi ti. Batın solid organları herniye olmamı tı.Sol posterolateral torakotomi yapıldı. Diyafragmanın posterolateralinde 8 cm uzunlu unda defekt ve buradanvisserlerin herniye oldu u görüldü. Peritoneal herni kesesi yoktu. Visserler batına ancak median laparotomi yapılarakredükte edilebildi. Postoperatif dönemde komplikasyon geli medi.ım torakotomi olmasına kar ın, masif organ herniasyonunda; organKronik tip diyafragma hernilerinde ilk yakla redüksiyonunda batının küçük olması nedeni ile ya anan zorluk ve malrotasyon varlı ı operasyona laparotomieklenmesini gerektirir.

Semptom vermeyen masif herniasyon: Dev erişkin tipi bochdalek hernisi

Adult type diaphragm hernias are seen usually in penetrating injuries. But herniation may be possible through thecongenital diaphragmatic defects in the adults which rarely occur.A 34-year-old male patient was admitted to the hospital because of the pathologic appearance in his control chestradiography. In his physical examination there was no abnormal finding except decreased breath sounds in thelower part of left hemithorax. It was detected that two-thirds of the left hemithorax was filled with the intestineexcept stomach and left colon in chest x-ray, CT and graphies with barium. There was no mediastinal shift.Abdominal solid viscera were not herniated. Posterolateral thoracotomy was performed. It was detected that therewas a 8 cm-diaphragmatic defect in the posterolateral portion of the diaphragm and intestinal viscera was herniatedthrough the defect to the thorax. There was no peritoneal sac. We could hardly manage the reduction of viscera tothe abdomen only after median laparatomy was performed. No complication was determined.Although, thoracotomy is the initial approach for the chronic diaphragmatic hernia, laparotomy should be added tothe procedure because of the difficulties in reduction of massive viscera herniation to the small abdomen andpresence of malrotation.

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