Bochdalek hernia with volvulus and invasive candida complication

Özet

A 1-year old girl was incidentally diagnosed as left posterolateral diaphragmatic hernia. Imaging methods like X-ray of the chest showed the herniation of gut loops and spleen (Figure 1). In the laparotomy, transverse colon, ascending colon and spleen were seen to enter the left throracic cavity and the organs were taken into the abdominal cavity. During the postoperative period, Candida albicans was cultured from urine and cathether-drawn blood cultures. On the postoperative fourth day, abdominal distension and intestinal obstruction occured. An emergency surgery was performed and necrosis of small bowels and ascending and transverse colon due to midgut volvulus were observed related with malrotation. Primary resection and anastomosis were performed for the gangrenous volvulus segment. Macroscopic examination of the intestinal segment revealed dark red to purple to black and thickened intestinal wall (Figure 2A). Microscopic examination of the reseced specimen disclosed congestion, edema, mucosal necrosis, and mild to severe perivascular inflamation. Invasive candida infection embedded in the mucosa was also observed. Presence of fungi was demonstrated by immunohistochemical staining with GrocottGomori methenamine-silver (GMS) and periodic acid-Schiff (PAS) (Figure 2B-2C). We describe a case of diaphragmatic eventration with colon volvulus and accompanying invasive candida infection. Although Bochdalek hernia eventration complicated by colon volvulus has been reported in the literature, there is not any report documenting hernia eventration complicated by colon volvulus accompanied by invasive candida infection (1,2).