PMC5472414_01
(A) A transverse computed tomography scan of the patient's chest on admission showing a large left-sided diaphragmatic hernia with bowel loops herniating into the left side of the chest, causing a mediastinal shift and resulting in small-bowel obstruction. (B) Axial CT of the abdomen showed intraperitoneal mesenteric folds.. Abbreviation: CT, computed tomography.
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To confirm the cause of vomiting, a chest radiograph, barium enema, and chest and abdomen computed tomography (CT) scans were performed, which showed a left-sided DH, with herniation of the small bowel and transverse colon into the left side of the chest and a mediastinal shift (Figures 1 and 2).
Preoperative barium enema shows dilated intestinal segments detected above the line of the diaphragm. The mediastinum is shifted to the right side.
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To confirm the cause of vomiting, a chest radiograph, barium enema, and chest and abdomen computed tomography (CT) scans were performed, which showed a left-sided DH, with herniation of the small bowel and transverse colon into the left side of the chest and a mediastinal shift (Figures 1 and 2).
At exploratory laparotomy, the partial transverse colon with the total small bowel had herniated through the left esophageal hiatus into the left pleural cavity. a, esophageal hiatus; b, colon ascendens; c, proximal empty field; d, terminal ileum; e, spleen; and f, appendix.
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The patient was taken to the operating room where the transverse colon (partial) with the small bowel (total) had herniated through the enlarged hiatus and migrated inside the left pleural cavity (Figure 3).