PMC10331128_01
Preoperative chest and abdominal radiograph. A preoperative chest radiograph shows bowel gas in the left thoracic cavity.
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However, chest and abdominal radiography performed on admission showed bowel gas in the left thoracic cavity (Figure 1).
Preoperative computed tomography. Computed tomography shows the transverse colon and intestine protruding into the left thoracic cavity. The route of the internal hernia begins from the retropancreatic fascial defect, passes through the dorsal aspect of the pancreatic body, and enters the left thoracic cavity through the left Bochdalek foramen. Pan, pancreas; Du, duodenum; TC, transverse colon; Sp, spleen; PV, portal vein; SpV, splenic vein; IVC, inferior vena cava; SMA, superior mesenteric artery; BH, Bochdalek hernia.
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A subsequent computed tomography (CT) revealed that the intestine and transverse colon had prolapsed through the orifice of the retropancreatic fascia hernia into the left thoracic cavity (Figure 2).
Intraoperative thoracoscopic findings. Thoracoscopic findings show that the intestine and colon are present in the thoracic cavity (A); the intestine and colon prolapse from the retropancreatic fascia hernia (*) into the Bochdalek hernia (B); the retropancreatic fascia hernia (*) is fully widened with scissors (C); the Bochdalek hernia is 30 mm in diameter (D); the defect hole is closed with 2-0 non-absorbable sutures (E); and the route of the retropancreatic fascia hernia into the Bochdalek hernia is shown as schema (F).
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Intraoperative findings showed that the intestine and colon had prolapsed into the left thoracic cavity as a Bochdalek hernia (Figure 3A). However, we found a hole in the internal hernia (Figure 3B) through the foramen of Bochdalek. The internal hernial orifice was completely widened using scissors (Figure 3C) to reduce the herniated organs. After reduction, the Bochdalek hernial orifice was measured 30 mm in diameter (Figure 3D) and was closed by suturing the diaphragm and intercostal muscles with 2-0 non-absorbable sutures (Figure 3E). A schema of the hernia route is shown in Figure 3F.