Incarcerated XXXX --differential diagnoses.

@entity1 @entity649 @entity4 @entity1514 @entity2914 @entity547
The incarceration of @entity2914 is very rare. We present a case of a four-year-old @entity1 who developed the incarceration of left-sided @entity2914 , who, until then, was completely asymptomatic. This incarceration of the @entity547 represented a surgical emergency presenting as obstructive ileus and a severe @entity649 which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain @entity1514 and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a significant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and @entity4 edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with aprevious control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the @entity1 and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax.
