title: Perforated Gastric Gangrene without Pneumothorax in an Adult Bochdalek Hernia due to Volvulus.
abstract: Bochdalek hernia is the most frequent congenital diaphragmatic hernia which occurs due to a defect in the posterior attachment of the diaphragm when there is a failure of closure of the pleuroperitoneal membrane in utero. It rarely presents for the first time in adults. We report one such case of a 23-year-old male patient who presented with an acute abdomen. Chest X-ray showed air under diaphragm and he was taken up for an emergency laparotomy. Intraoperatively an organoaxial volvulus of the stomach was found in a bochdaleks hernia with a focal gangrene of the stomach fundus with perforation and peritonitis. However, there was no breach of pleural cavity. A sleeve resection of the gangrenous portion of the stomach was performed and the diaphragmatic defect was repaired. Patient made an uneventful postoperative recovery. Gastric gangrene with perforation as a manifestation of the adult bochdalek hernia is indeed rare. A concomitant pneumothorax occurs along with this condition which requires an intercostal drainage tube prior to the laparotomy. We report this case for its unique presentation without pneumothorax.
authors.affiliation: Specialist, Department of G.I. Surgery, Lakeshore Hospital and Research Centre , Maradu, Nettoor PO, Kochi, India .
authors.forename: John Mathew
authors.initials: JM
authors.lastname: Manipadam
authors.affiliation: Resident, Department of G.I. Surgery, Lakeshore Hospital and Research Centre , Maradu, Nettoor PO, Kochi, India .
authors.forename: George Mathew
authors.initials: GM
authors.lastname: Sebastian
authors.affiliation: Senior Consultant, Department of G.I. Surgery, Lakeshore Hospital and Research Centre , Maradu, Nettoor PO, Kochi, India .
authors.forename: Venugopal
authors.initials: V
authors.lastname: Ambady
authors.affiliation: Professor and Head, Department of G.I. Surgery, Lakeshore Hospital and Research Centre , Maradu, Nettoor PO, Kochi, India .
authors.forename: Ramesh
authors.initials: R
authors.lastname: Hariharan
keywords: Duodenal ulcer perforation; Laparotomy; Organoaxial volvulus