The routine laboratory studies were unremarkable. Chest radiograph showed left-sided pleural effusion and elevated left hemidiaphragm. The computed tomography (CT) of the abdomen showed a diaphragmatic

defect with herniation of the stomach, small intestine, and colon into the left thoracic cavity. The herniated stomach had a twisting constriction in the body of the stomach (Figs 1,2). Thoracotomy was performed and a diaphragmatic defect, measuring 4 × 6 cm, was identified. Reduction of the herniated viscera and mesh repair of the defect was undertaken. The postoperative Dabrafenib supplier course was uneventful and the patient was discharged 7 days after the operation. Bochdalek’s hernia is the common type of the congenital diaphragmatic hernia typically diagnosed in neonatal and postnatal patients with the prevalence of one out every 2,200-12,500 births, but is rare in adults. Bochdalek’s hernia is secondary to maldevelopment and/or defective fusion of the pleuroperitoneal

membrane, which leads to a posterolateral defect in the diaphragm. Most of the hernias (80 to 90%) are found on the left side. The majority of reported cases of Bochdalek’s hernia present with cardiorespiratory symptoms in the neonatal period. In adults, most Bochdalek’s hernias are asymptomatic, and their detection is usually incidental. The major clinical manifestations of Bochdalek’s hernias in adults consist of gastrointestinal symptoms, and sometimes respiratory symptoms. The herniated visera may include the stomach, small and large bowels, spleen, liver, kidney and omentum. Volvulus of the stomach is a relatively uncommon Cediranib (AZD2171) Ceritinib mw condition and may result from the stomach twisting around the longitudinal or mesenteric axis. Most cases of gastric volvulus are associated with diaphragmatic herniation or eventration. Bochdalek’s hernias are usually suspected on routine chest

radiographs, appearing as an abnormal abdominal gas pattern with either a soft tissue mass in the chest or evidence of intrathoracic bowel gas. Chest CT may directly visualize the focal defect of the diaphragm and can identify a mass or fat or soft tissue contour of the upper surface of the diaphragm. Management of Bochdalek’s hernia includes reducing the abdominal contents and repairing the defect through a laparotomy or thoracotomy. Contributed by “
“The falciform (sickle-shaped) ligament is one of five ligaments that connect the liver to the under-surface of the diaphragm and to the anterior abdominal wall. It passes in an antero-posterior plane and is the embryonic remnant of the ligamentum teres and the para-umbilical veins wrapped within two layers of peritoneum. It may contain a variable amount of extra-peritoneal fat and represents a potential space. In infants, falciform ligament inflammation or necrosis can occur as a complication of omphalitis.