İnsidental Olarak Saptanan Bochdalek Hernilerinin ÇKBT ile Değerlendirilmesi:

Year 2017, , 157 - 162, 25.09.2017

Zafer Özmen , Eda Albayrak

https://doi.org/10.21673/anadoluklin.325702

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.

Keywords

Bochdalek Hernisi; Çok kesitli bilgisayarlı tomografi; Diyafragma

Evaluation of Incidental Bochdalek’s Herniae with MDCT:

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.

Keywords

Bochdalek Hernia; Multidetector Computed Tomography; diaphragma

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