title: Complicated adult right-sided Bochdalek hernia with Chilaiditi's syndrome: a case report.
abstract: An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi's syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi's sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. motowide@aol.com.|Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. motowide@aol.com.|Department of Surgery, Moriya Daiichi General Hospital, 1-17 Matsumaedai, Moriya, Ibaraki, 302-0102, Japan. motowide@aol.com.
authors.forename: Motonobu
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. oishibashi@yahoo.co.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishibashi
authors.affiliation: Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. watanabemuneaki@nifty.com.
authors.forename: Muneaki
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. kondo-t@md.tsukuba.ac.jp.|Department of Surgery, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 310-0015, Japan. kondo-t@md.tsukuba.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8558, Japan. nokochi3@md.tsukuba.ac.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
keywords: Bochdalek hernia; Chilaiditi's syndrome; In adults; Strangulated ileus