¹Muhammad Shaheer Saleem, ¹Wen-Zhang Zha, ¹Yong Zhou, ¹Fu-Ming Xuan, ³Samia Abbas, ²Hamza Maqbool, ¹Madni Abbas

¹General Surgery Department, Yancheng 1st People’s Hospital, Affiliated Hospital of Xuzhou Medical University, Yancheng 224000, Jiangsu Province, China

²Neurology Department, Yancheng 1st People’s Hospital, Affiliated Hospital of Xuzhou Medical University, Yancheng 224000, Jiangsu Province, China

³Radiology Department, Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan

Corresponding Author: Zha Wen Zhang, Frcs, Phd, Full Professor, General Surgery, Yancheng First People HOSPITAL, No.166, Yulong West Road, Tinghu Yancheng Jiangsu China, Yancheng 224000, Jiangsu Province, China, Email: wenzhang@sina.cn; Yong Zhou, Phd, General Surgery, Yancheng First People Hospital, No.166, Yulong West Road, Tinghu Yancheng Jiangsu China, Yancheng 224000, Jiangsu Province, China, Email: zhouyong13616@sina.com

Citation: Muhammad Shaheer Saleem, Wen-Zhang Zha, Yong Zhou, Fu-Ming Xuan, Samia Abbas, Hamza Maqbool, Madni Abbas, (2024). Surgical Management of Congenital Transdiaphragmatic Hernia with Abdominal Wall Involvement in an Adult: A Case Report. American J Case Rep Clin Imag. 2024; 1(1)1-6.

Copyrights © 2024, Zha Wen Zhang, et al. This article is licensed under the Creative Commons Attribution-Non-Commercial-4.0-International-License-(CCBY-NC) (https://americanjournalofcasereports.com/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

ABSTRACT:

Background

Congenital Transdiaphragmatic Hernia (CTDH) in adults is rare, often presenting with abdominal wall hernias, which complicates diagnosis and treatment. This case report discusses a 56-year-old male with intermittent upper abdominal discomfort, pleural effusion, and respiratory distress. CT scans identified a transdiaphragmatic intercostal hernia with pleural complications. Emergency intervention revealed necrotic omentum and high pleural fluid volume, highlighting the diagnostic complexity and need for prompt management in CTDH patients.

AIM: To determine the diagnostic and therapeutic approach for CTDH in adults with abdominal wall hernia and pleural complications.

METHODS: A case study was conducted in a hospital setting on a 56-year-old male presenting with symptoms of abdominal discomfort and respiratory distress. Contrast-enhanced CT imaging identified CTDH and abdominal wall hernia, with pleural effusion and atelectasis. The patient underwent emergency laparotomy, drainage of 2500 ml pleural fluid, hernia sac repair, and pleural drainage. Recovery was assessed with follow-up imaging to monitor resolution of pleural and pulmonary conditions.

RESULTS: Emergency laparotomy revealed an incarcerated, necrotic omentum within the hernia sac, which was surgically removed. Approximately 2500 ml of dark pleural fluid was drained, and pleural drainage was performed. Post-surgery, the patient experienced significant recovery with full restoration of lung function and no postoperative complications. Follow-up imaging confirmed resolution of pleural effusion and atelectasis, demonstrating successful surgical intervention and recovery.

CONCLUSION: Early diagnosis and individualized surgery are critical in managing adult CTDH, reducing risk of organ strangulation and respiratory failure.

Keywords: Transdiaphragmatic intercostal hernia, Abdominal wall hernia, Pleural effusion, Atelectasis, Surgical management. Case report

Core Tip:

This report examines a rare adult case of Congenital Transdiaphragmatic Hernia (CTDH) in a 56-year-old with abdominal wall hernia and pleural effusion. Early CT imaging provided critical insights into the hernias and respiratory complications. Emergency laparotomy, including hernia repair and pleural drainage, led to successful resolution. This case underscores the necessity of prompt, individualized surgical intervention to prevent life-threatening complications like organ strangulation, especially in patients with elevated BMI, which heightens intra-abdominal pressure. The findings highlight the need for early detection and multidisciplinary management in adult CTDH cases.