PMC9926363_01
Initial radiographic images of the adult right-sided BH (before surgery): (a) an upright Chest X-ray left arrow showing air-fluid level, right arrow showing the column air-fluid level in the right hemithorax and left directed arrow showing the column air-fluid level in the descending colon, (b), (c): Coronal sequences of thoracoabdominal CT scan showing herniation of liver (white star), ascending and transverse colon (white empty arrow) into hemithorax with the obstructed site of descending colon (white full field arrow, bird beak sign).
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Table 1. The chest and abdominal X-rays were performed and showed large opacity in the right hemithorax that combined with an air-fluid level in the right hemithorax (Figure 1a). After primary fluid resuscitation, a thoracoabdominal CT scan without IV contrast was made, which confirmed a right-sided diaphragmatic hernia with herniation of the ascending colon and liver into the right hemithorax (Figure 1b and c).
Radiographic image of the adult BH after operation, complete expansion of the right lung.
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Intraoperatively; it revealed that the liver, ascending colon and transverse colon were present in the right hemithorax (Figure 2).
Intra operative (posterolateral thoracotomy) image with no sign of hernia sac. Hepatic flexure of the colon (triangle), right lobe of the liver (star), the right medial lobe of lung (circle), right lower lobe of lung (Square).
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Postoperative chest X-rays showed that the right lung was completely expanded (Figure 3).Two days after the initial operation, urine volume decreased by a 0.03 cc per hour, metabolic acidosis developed, serum creatinine, and heart rate increased (130 per minute), and reductions were found in blood pressure and the level of consciousness.