• Journal of Chest Surgery
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• v.44 no.6
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• pp.455-457
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• 2011

A 70-year-old male visited urgent care due to coughing for 1 month and left chest pain. He had no history of trauma. The initial chest computed tomography (CT) showed the 7th left intercostal lung herniation. A follow-up CT showed an intercostal lung herniation combined with a bowl herniation, which had developed due to a Morgagni's hernia. An emergency operation was performed due to the incarceration of the bowl and lung. The primary repair of the diaphragm was performed and the direct approximation of the 7th intercostal space was determined. We concluded that the defect of the diaphragm and the intercostal muscle was a congenital lesion, and the recurrent coughing was the aggravating factor of herniation.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.640-643
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• 1995

Bochdalek hernia is the congenital posterolateral defect in the diaphragm caused by a failure of the pleuroperitoneal canal to close at 8 weeks, gestation. Infants with hernia diagnosed at birth have poor prognosis. Survival rate depends on pulmonary growth and development, preoperative stability and postoperative care. We experienced two cases of Bochdalek hernia, one in right was repaired with patch closure using sheet and the other in left was repaired with simple closure.

• Journal of Trauma and Injury
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• v.32 no.1
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• pp.66-70
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• 2019

Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.417-421
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• 1993

Congenital diaphragmatic hernia through Bochdalek foramen, posterolateral diaphragmatic hernia, is the result of a congenital malformation of the posterolateral region of the diaphragm. Bochdalek hernia is the most common type of congenital diaphragmatic hernia, but it is a extremely rare anomaly which is detected in adulthood because it has severe cardiopulmonary and gastrointestinal symptoms after birth immediately.We experienced two cases of Bochdalek hernia which were detected in adulthood. Among them, one was a 43 years old man who was treated with simple closure in left Bochdalek hernia and the other was 41 years old woman who was treated with patch closure using silastic sheet in right Bochdalek hernia. Their postoperative courses were uneventiful. So we report two cases of rare Bochdalek hernia which was detected in adulthood with review of literatures.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.573-578
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• 2006

Background: Generally hernia is diagnosed with simple chest or gastrointestinal x-ray. Sometimes CT or MRI can give lots of information for the diagnosis. However, there was no study for the differentiation with using CT findings between Morgagni hernia and pleuropericardial fat. The aim of this study was to evaluate the useful CT findings for differentiating Morgagni hernia from pleuropericardial fat. Material and Method: We retrospectively analyzed CT scans of eight patients with Morgagni hernia and 20 patients with abundant pleuropericardial fat without peridiaphragmatic lesions. All CT scans were performed with coverage of the whole diaphragm in the inspiration state. We evaluated 1) the presence of the defect of the anterior diaphragm, 2) the interface between the lung and fat, 3) the angle between the chest wall and fat, 4) the continuity between the extrapleural fat and fat, 5) the presence of the vessels within fat, and 6) the presence of a thin line surrounding fat. Result: In all cases with Morgagni hernia, the defect of the anterior diaphragm was seen. The interface was well-defined, smooth, and convex to the lung. The angle with the chest wall was acute. The continuity with the extrapleural fat was not seen. In the cases with abundant pleuropericardial fat, the defect of the anterior diaphragm was seen in three (15%). The interface was usually irregular (n=10) and flat (n=17). The angle with the chest wall was variable. The continuity with the extrapleural fat, that was markedly increased in amount, was usually seen (n=16). The thin line surrounding fat was seen in four cases with Morgagni hernia, however, not seen in all cases with pleuropericardial fat. All of the above findings were statistically significant, however, vessels within fat was not significant to differentiate Morgagni hernia (n=8/8) from pleuropericardial fat (n=14/20). Conclusion: The useful CT findings of Morgagni hernia were fatty mass with sharp margin, convexity toward lung, acute angle with chest wall, and thin line surrounding hernia. Branching structure within fatty mass representing omental vessels that has been known as a characteristic finding of Morgagni hernia was not useful for differentiating Morgagni hernia from pleuropericardial fat.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1088-1091
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• 1989

Foramen of Morgagni hernia is the least common type of all congenital diaphragmatic hernias. These foraminal hernias result from a congenital defect in the development or attachment of the diaphragm to the sternum and costal arch. They occur most commonly on the right side, possibly because of pericardial reinforcement of the left. In our case, occurred on the right side and the contents of the hernial sac were omental fat and a part of transverse colon. We performed transthoracic approach for reduction and repair of foraminal hernia with ligation and interrupted mattress sutures of the margin of the defected diaphragm to the posterior part of the sternum and costal cartilage. The postoperative course was uneventful except posttraumatic delirium and discharged at 21st postoperative day.

• Journal of Veterinary Clinics
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• v.26 no.1
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• pp.62-68
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• 2009

A diaphragm is a musculotendinous partition that separates abdominal and thoracic organs and assists in ventilation. Three dogs were presented after being hit by a car, and one dog was presented with the history of respiratory problems including intermittent dyspnea and coughing. Survey thoracic radiography, positive contrast celiography and sonography revealed traumatic diaphragmatic hernia in three dogs and congenital peritoneopericardial diaphragmatic hernia in one dog. In three dogs including a dog with congenital peritoneopericardial diaphragmatic hernia, herniorrhaphy was performed. Among the three dogs underwent surgery, two dogs with traumatic diaphragmatic hernia recovered uneventfully. However the dog with congenital peritoneopericardial diaphragmatic hernia died from pulmonary edema at 2 days after surgery. Positive-contrast ceilography and ultrasonography provides to investigate the integrity of the diaphragm. Chronic diaphragmatic hernia and concurrent injuries are considered as prognostic factors.

• Journal of Veterinary Clinics
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• v.16 no.2
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• pp.478-481
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• 1999

A 8 years old male Pomeranian weighing 4 kg was referred because of coughing of 4 months' duration. Heart sounds and cardiac apex beat were showed more intense on the right side. On radiographic views, loss of normal line of the diaphragm, gas-containing intestines and stomach in thoracic cavity, and right displacement of heart were observed. Ultrasonography revealed that liver located adjacent to the heart. Although the dog died due to severe respiratory disorder in surgical procedure, in thoracic and abdominal surgery, a large defect was found in the left and right ventral muscular portion and left central tendon of the diaphragm, extending from the esophageal hiatus to rib. Left and right cranial lobe of liver, small intestines, stomach and spleen were herniated in the thoracic cavity. Because of the size and chronicity of the defect in the diaphragm, closure was impossible with an abdominal muscle graft.

• Journal of Chest Surgery
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• v.2 no.1
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• pp.59-64
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• 1969

Three cases of traumatic diaphragmatic hernia were repaired in this department from June 1967 to Nov.1968. The first case, a 14 year old girl, was diagnosed as diaphragmatic hernia during the operation of the diffuse peritonitis from jejunaI perforation 3 days after the traffic accident at local clinic and she was transfered to this hospital after the closure of the perforated jejunum. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture at the posterolateral portion of the left diaphragm was repaired with two layer sutures by transthoracic approach. The second case. a 26 year old man. was diagnosed immediately after the traffic accident at local clinic and transfered to this hospital 24 hours later. Herniated and distended stomach, transverse colon and jejunum were repositioned and the large diaphragmatic rupture, about 9 cm in length, from the posterolateral portion to the base of the pericardium was directly repaired with two layer sutures. The third case, a 26 year old man, who had a history of stab wound at left lower lateral chest two years ago,was admitted with the sudden onset of abdominal pain and vomiting. The diaphragmatic hernia was confirmed with barium enema. The herniated stomach and transverse colon through the defect, about 3.5 cm in diameter, at anterolateral portion of the left diaphragm, were repositioned and the defect was repaired with two layer sutures. All of the cases recovered uneventfully.

• Journal of Veterinary Clinics
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• v.22 no.4
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• pp.435-438
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• 2005

Two dogs (case 1:2-year-old intact male German Shepherd-mixed dog and case 2: 4-year-old intact female Jindo miked) with perineal hernia were referred to the Chonbuk Animal Medical Center, Chonbuk National University. In the both cases, there were unilateral perineal swelling involving the right side of the anus. In addition, in case 2, swelling was also present ventral to the anus. Rectal palpation of pelvic diaphragm revealed weakness of the muscles. Both cases were surgically treated using muscle transposition technique for hemiorrhaphy. In case 1, transposition of the superficial gluteal and internal obturator muscles and in case 2, transposition oi semitendinosus muscle was performed for hemiorrhaphy and reconstruction of the pelvic diaphragm. Both dogs became recovered after the surgical correction and no complications were observed during 10-month (casel) and 9-month(case2). Muscle transposition can be a useful technique for the treatment of perineal hernia in the dog.