Abstract
Giriş ve Amaç: Erişkinde
çok kesitli bilgisayarlı tomografi ile insidental olarak saptanan asemptomatik Bochdalek
Hernilerinin sıklığını araştırmak, obezite ve diyafragma krus kalınlığı ile BH
arasındaki ilişkiyi değerlendirmektir.
Gereç
ve Yöntemler: 870 adet toraks ve abdomen çok kesitli
bilgisayarlı tomografi tetkiki retrospektif olarak tarandı. Bochdalek Hernisi
varlığı, prevalansı ve herni lokalizasyonu araştırıldı. Bochdalek Hernisi
saptanan hastalarda aksiyal kesitlerde, defekt komşuluğundan diyafragma krus
kalınlığı ve umblikus hizasında sağ paramedian alandan ciltaltı yağ dokusu
kalınlığı ölçüldü. Ayrıca defektin boyutu ve herni kesesinin hacmi de aynı
görüntülerde hesaplandı. Daha sonra defekt boyutları ve herni kesesinin hacmi
ile diyafragma krus kalınlığı ve ciltaltı yağ dokusu kalınlığı arasında ilişki
olup olmadığı araştırıldı.
Bulgular:
30 hastada toplam 34 adet (%3,9) Bochdalek Hernisi saptandı. Bochdalek Hernisi
13 (%43.3) hastada sağda, 13 (% 43.3)
hastada solda, 4 (%13.3) hastada ise bilateraldi. Herni kesesinin
içeriği 32 (%94) hastada omental yağ dokusundan, 1 (%3) hastada karaciğerden, 1
(%3) hastada ise kolondan oluşmaktaydı. Herniye segment hacmi kadın hastalarda 153[84-361]
µl, erkek hastalarda 339[202-432,5] µl hesaplanmış olup, bu değer kadın
hastalarda istatistiksel açıdan anlamlı olacak şekilde daha düşüktü (p=0.032).
Diyafragma krus kalınlığı ve ciltaltı yağlı doku ile hem herniye segment hacmi
hem de defekt boyutu arasında anlamlı bir ilişki izlenmedi (p>0.05).
Sonuç:
Mevcut
çalışmada çok kesitli bilgisayarlı tomografi ile saptanan, insidental Bochdalek
Hernisi sıklığı % 3.9’dur ve herniye segment hacmi kadınlarda erkeklere oranla
daha düşük bulunmuştur. Obezite diğer intraabdominal hernilerin patogenezinde
önemli bir rol oynamasına rağmen, asemptomatik insidental Bochdalek Hernisi ile
obezite ve diyafragma krus kalınlığı arasında anlamlı bir ilişki
saptanmamıştır.
References
- 1. Losanoff JE, Sauter ER. Congenital posterolateral diaphragmatic hernia in an adult. Hernia 2004; 8:83–85.
- 2. Skandalakis JE, Gray SW. Embryology for surgeons, 2nd ed. Baltimore: Williams and Wilkins, 1994;502–15.
- 3. Goh BK, Teo MC, Chng SP, Soo KC. Right-sided Bochdalek’s hernia in an adult. Am J Surg 2007;194:390-91
- 4. Salacin S, Alper B, Cekin N, Gulmen MK. Bochdalek hernia in adulthood: a review and an autopsy case report. J Forensic Sci 1994; 39:1112–16.
- 5. La Ganga V, Rossi G, Montobbio A, Gaione M. [Bochdalek's diaphragmatic hernia in adults. Description of a clinical case] Minerva Chir 1999; 54:443-45.
- 6. Kinoshita F, Ishiyama M, Honda S, et al. Late-presenting posterior transdiaphragmatic (Bochdalek) hernia in adults: prevalence and MDCT characteristics. J Thorac Imaging 2009; 24:17–22.
- 7. Mullins ME, Stein J, Saini SS, et al. Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR 2001;177:363-66.
- 8. Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology 1985;156:449-52.
- 9. Feuerlein S, Kern M, Muche R, Ernst AS, Juchems MS, Pauls S. Cisterna chyli in patients with malignancy--is there a correlation between changes in cisterna volume and progression or regression of the tumor? Eur J Radiol. 2010;76:177-179.
- 10. Robb BW, Reed MF. Congenital diaphragmatic hernia presenting as splenic rupture in an adult. Ann Thorac Surg 2006; 81:9–10.
- 11. Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology 1985; 156:449–52.
- 12. Pelizzo G, Lembo MA, Franchella A, Giombi A, D’Agostino F, Sala S. Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings.Abdom Imaging 2001; 26:306–08.
- 13. Sakorafas GH, Delibasis G. Large right congenital diaphragmatic (Bochdalek) hernia: an incidental finding in an aged patient with acute intestinal obstruction. Dig Surg 2001;18:431.
- 14. Baglaj M, Dorobisz U. Late-presenting congenital diaphragmatic hernia in children: a literature review. Pediatr Radiol 2005; 35:478–88.
- 15. Chai Y, Zhang G, Shen G. Adult Bochdalek hernia complicated with a perforated colon. J Thorac Cardiovasc Surg 2005;130:1729–30.
- 16. Eren S, Ciris F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol 2005;54:448–59.
- 17. Habib E, Bellaiche G, Elhadad A. Complications of misdiagnosed Bochdalek hernia in adults. Ann Chir 2002;127:208–14.
- 18. Temizöz O, Gençhellaç H, Yekeler E, Umit H, Unlü E, Ozdemir H, Demir MK. Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population. Diagn Interv Radiol. 2010;16:52-55.
- 19. Dessy LA, Mazzocchi M, Fallico N, Anniboletti T, Scuderi N. Association between abdominal separation and inguinal or crural hernias: our experience and surgical indications. J Plast Surg Hand Surg. 2013; 47:209-12.
- 20. Ruhl CE1, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165:1154-61.
- 21. Knox RD, Berney CR. A preoperative hernia symptom score predicts inguinal hernia anatomy and outcomes after TEP repair. Surg Endosc. 2015; 29: 481-86.
- 22. Lambert DM, Marceau S, Forse RA. Intraabdominal pressure in the morbidly obese. Obes Surg 2005; 15:1225–32.
- 23. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JG, Ruijs JH. Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Eur J Clin Nutr. 1988; 42:805–15
Abstract
Introduction:
The objective of this study was to investigate the incidence of asymptomatic
Bochdalek’s herniae detected incidentally with Multidetector Computed
Tomography and to evaluate the
correlation of Bochdalek herniae with obesity and the thickness of the
diaphragmatic crus.
Materials
and Methods: A retrospective screening of the 870
multidetector computed tomography images of thorax and abdomen were performed.
The prevalence and localization of Bochdalek herniae were investigated. In
patients with Bochdalek herniae, the thickness of the diaphragmatic crus from
the border of the defect and the thickness of the subcutaneous fat tissue in
the right paramedian area at the level of umbilicus were measured in the axial
sections. In addition, the size of the defect and the hernia sac volume were
calculated in the same images. Then, the presence of a correlation between
defect sizes and hernia sac volumes and the thickness of the diaphragmatic crus
and subcutaneous fat tissue were evaluated.
Results:
34 BH (3.9%) were detected in 30 patients. Bochdalek herniae was on the left
side in 13 patients (43.3%), on the right side in 13 patients (43.3%) and was
bilateral in 4 patients (13.3%). The content of the hernia sac consisted of
omental fat tissue in 32 patients (94%), of liver in 1 patient (3%) and of
colon in 1 patient (3%). The segmental volume of hernia was lower in female
patients [153µ;84µ -361µ] thanin male patients
[339µ; 202µ -432.5µ] and the difference was statistically significant
(p=0.032). There was no significant correlation between the thickness of the
diaphragmatic crus and the subdermal fat tissue and both segmental volume and
defect size of hernia (p>0.05).
Conclusions:
In the present study, the incidence of the incidental Bochdalek herniae
detected with Multidetector Computed Tomography is 3.9% and the segmental
volume of hernia is significantly lower in females compared with males.
Although obesity plays an important role in the pathogenesis of intraabdominal
hernia, no significant correlation between the asymptomatic incidental Bochdalek
herniae and obesity and thickness of the diaphragmatic crus was detected.
References
- 1. Losanoff JE, Sauter ER. Congenital posterolateral diaphragmatic hernia in an adult. Hernia 2004; 8:83–85.
- 2. Skandalakis JE, Gray SW. Embryology for surgeons, 2nd ed. Baltimore: Williams and Wilkins, 1994;502–15.
- 3. Goh BK, Teo MC, Chng SP, Soo KC. Right-sided Bochdalek’s hernia in an adult. Am J Surg 2007;194:390-91
- 4. Salacin S, Alper B, Cekin N, Gulmen MK. Bochdalek hernia in adulthood: a review and an autopsy case report. J Forensic Sci 1994; 39:1112–16.
- 5. La Ganga V, Rossi G, Montobbio A, Gaione M. [Bochdalek's diaphragmatic hernia in adults. Description of a clinical case] Minerva Chir 1999; 54:443-45.
- 6. Kinoshita F, Ishiyama M, Honda S, et al. Late-presenting posterior transdiaphragmatic (Bochdalek) hernia in adults: prevalence and MDCT characteristics. J Thorac Imaging 2009; 24:17–22.
- 7. Mullins ME, Stein J, Saini SS, et al. Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR 2001;177:363-66.
- 8. Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology 1985;156:449-52.
- 9. Feuerlein S, Kern M, Muche R, Ernst AS, Juchems MS, Pauls S. Cisterna chyli in patients with malignancy--is there a correlation between changes in cisterna volume and progression or regression of the tumor? Eur J Radiol. 2010;76:177-179.
- 10. Robb BW, Reed MF. Congenital diaphragmatic hernia presenting as splenic rupture in an adult. Ann Thorac Surg 2006; 81:9–10.
- 11. Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology 1985; 156:449–52.
- 12. Pelizzo G, Lembo MA, Franchella A, Giombi A, D’Agostino F, Sala S. Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings.Abdom Imaging 2001; 26:306–08.
- 13. Sakorafas GH, Delibasis G. Large right congenital diaphragmatic (Bochdalek) hernia: an incidental finding in an aged patient with acute intestinal obstruction. Dig Surg 2001;18:431.
- 14. Baglaj M, Dorobisz U. Late-presenting congenital diaphragmatic hernia in children: a literature review. Pediatr Radiol 2005; 35:478–88.
- 15. Chai Y, Zhang G, Shen G. Adult Bochdalek hernia complicated with a perforated colon. J Thorac Cardiovasc Surg 2005;130:1729–30.
- 16. Eren S, Ciris F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol 2005;54:448–59.
- 17. Habib E, Bellaiche G, Elhadad A. Complications of misdiagnosed Bochdalek hernia in adults. Ann Chir 2002;127:208–14.
- 18. Temizöz O, Gençhellaç H, Yekeler E, Umit H, Unlü E, Ozdemir H, Demir MK. Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population. Diagn Interv Radiol. 2010;16:52-55.
- 19. Dessy LA, Mazzocchi M, Fallico N, Anniboletti T, Scuderi N. Association between abdominal separation and inguinal or crural hernias: our experience and surgical indications. J Plast Surg Hand Surg. 2013; 47:209-12.
- 20. Ruhl CE1, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165:1154-61.
- 21. Knox RD, Berney CR. A preoperative hernia symptom score predicts inguinal hernia anatomy and outcomes after TEP repair. Surg Endosc. 2015; 29: 481-86.
- 22. Lambert DM, Marceau S, Forse RA. Intraabdominal pressure in the morbidly obese. Obes Surg 2005; 15:1225–32.
- 23. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JG, Ruijs JH. Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Eur J Clin Nutr. 1988; 42:805–15
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | ORIGINAL ARTICLE |
| Authors | |
| Publication Date | September 25, 2017 |
| Acceptance Date | August 9, 2017 |
| Published in Issue | Year 2017 Volume: 22 Issue: 3 |
This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.