呼吸困難のまれな原因。成人の右側Bochdalekヘルニア

A Rare Cause of Dyspnoea: Right-sided Bochdalek Hernia in an Adult.

• David Rocha Paiva
• Daniela Casanova
• Helio Martins
• Margarida Cerqueira
• Mariana Formigo
• Olinda Miranda
• Jorge Cotter

抄録

右側Bochdalekヘルニア（BH）は成人ではほとんど診断されません。一般的に消化器症状（痛み、腹部膨満感、嘔吐）を呈します。呼吸困難、胸部感染症の再発、その他の肺の後遺症を呈することもある。3 日間の呼吸困難、発熱、胸部痛、嘔吐を複数回繰り返した 92 歳男性の症例を報告する。レントゲン撮影を行い，胸部CT検査で大規模なBHヘルニアと診断された．小腸が壊死や穿孔を起こした場合には致命的な状態になる可能性がある。緊急開腹手術が行われたが、患者は臨床的に改善せず、手術後すぐに死亡した。

Right-sided Bochdalek hernia (BH) is very rarely diagnosed in adults. It commonly presents with gastrointestinal symptoms (pain, abdominal distension and vomiting). Breathlessness, recurrent chest infections and other pulmonary sequelae can also be present. We report the case of a 92-year-old man with a 3-day history of dyspnoea, fever and thoracic pain and multiple episodes of vomiting. An x-ray was performed, and the diagnosis of a large BH hernia was confirmed by computed tomography of the thorax. The condition may be fatal in cases where the small bowel undergoes necrosis or perforation. An emergent laparotomy was performed, but the patient did not improve clinically and died immediately after the procedure.

学習ポイント:

BHの転帰は、症状、早期診断、緊急介入に依存する。

LEARNING POINTS: Right-sided Bochdalek hernia (BH) is very rarely diagnosed in adults.Misdiagnosis of BH as a tension pneumothorax (which has a similar clinical presentation) can delay treatment and put patients at risk.The outcome of BH depends on the presentation, early diagnosis and emergent intervention.

© EFIM 2020.