成人にみられたBochdalek孔ヘルニアの1治験例

A Case of Diaphragmatic Hernia through the Foramen Bochdalek in an Adult

　近年，小児外科分野の著しい進歩に伴って，横隔膜ヘルニア，とくにBochdalek孔ヘルニア（胸腹裂孔ヘルニア）の新生児期治験例の報告が数多くみられるが，成人例はまれのように思われる．最近，われわれは29歳女性に発症した本症の1治験例を経験したので，2，3の文献的考察を加えて報告する．

　A 29-year-old housewife was admitted to our hospital complaining of nausea, vomiting and backache. She had been sufferring from substernal pain apparently without any cause. Although diaphragmatic hernia was suspected then, she had no medical treatment. Since October 1969, when she was delivered of her second child, she began again to have nausea and vomiting after meals together with radiating pain to the back. Before entry, she developed difficulty in swallowing solid food. Admission on January 7, 1970.

　The patient was well developed but rather poorly nourished. Conjunctivae showed no sign of anemia or jaundice. Thorax was normal and symmetric. The heart was slightly shifted to the right. The percussion note was tympanitic below the fifth rib on the left mammillary line, where respiratory and peristaltic sounds were absent. Laboratory findings showed no abnormalities except slight anemia and leucocytosis. Vital capacity was 2300ml and ％VC was 78％. Chest x-ray film disclosed a convex strand in the posterior portion of the lung at the height of the second rib. Below that region, atelectatic finding of the lung and a dense shadow with fluid level were observed. X-ray examination of the gastrointestinal tract revealed congenital diaphragmatic hernia. Surgical operation was accordingly performed.

　On laparotomy, the entire stomach was in the peritoneal cavity, but the pylorus was easily movable. The whole picture suggested easy shift of the stomach to the pleural cavity. The foramen of Bochdalek (pleuroperitoneal hernia), measuring 7.0×4.5 cm, was found in the slightly posterior part of the left lobe of the liver, with spleen and some portions of the small intestine and colon entering the pleural cavity through the foramen. Radical operation was done successfully. The patient has been in good condition.

　Although diaphragmatic hernia has been found more often in recent years, a hernia through the foramen of Bochdalek is still relatively rare. Still less so is the present case, in which radical operation was performed subsequently to the appearance of various symptoms after her second delivery. Some reference has also been made to the literature.