부산대학교 도서관

Most of the congenital diaphragmatic hernia can be easily classified into three major categories from the location of the hernia orifice, but in a case with atypical location of the orifice and with non-muscular membranous sac, one may be embarrassed to define it. This is a case report of one-day-old female infant with a left sided diaphragmatic hernia whose initial symptom was hematemesis. She started to vomit caffee ground material from the next day of life. There was neither dyspnea nor cyanosis. A scout film of the abdomen revealed a large gas shadow with an air-fluid level in the upper quadrant of the abdomen (Fig. 1). No other abdominal gas shadow was visible except in the rectum. Gastrografin examination disclosed the dilated esophagus with tapered narrowing in the distal end and the up-sidedown stomach with complete obstruction of the outlet showing a beak (Fig. 3). At laparotomy, the anterior portion of the left diaphragm was thin and membranous but the posterior half was seemed normal. The anterior half was imbricated and sutured to the posterior half of the diaphragm (Fig. 5). Excised portion of the anterior half of the diaphragm had no muscular layer. The postoperative course of the patient was uneventful. There are many arguments about the histological findings and the definition of localized eventration of the diaphragm and diaphragmatic hernia with sac. It seems unable and unnecessary to distinguish these two conditions clinically. It is postulated that acute volvulus of the stomach is a cause of gastric rupture associated with diaphragmatic hernia including eventration.