Presentation
Loss of weight and dyspnea.
Patient Data
A large left diaphragmatic hernia is seen. The diaphragmatic defect measuring 6 x 8 cm. It is seen admitting the whole stomach, small bowel loops and the transverse colon as well as the distal aspect of the superior mesenteric artery and its branches. The body, tail of pancreas and the splenic vessels are also seen herniating into the thorax. Its head and uncinate process as well as the C-loop of the duodenum are seen at the upper abdomen immediately below the diaphragm.
Diminished volume of the left hemithorax with atelectasis at the lingular segments of the upper lobe. Mediastinal shift to the right side ( heart and trachea).
Hepatosplenomegaly is also noted as well as minimal ascites.
Case Discussion
Diaphragmatic hernia can reach large size due to the negative intra-thoracic pressure, retroperitoneal or intra-abdominal organs and tissues can prolapse into the thoracic cavity. Its content depends on the location and size of the defect.
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