A Lady with Severe Abdominal Pain Following a Zumba Dance Session: A Rare Presentation of Bochdalek Hernia

Abstract

A Bochdalek hernia is a congenital diaphragmatic hernia that results from a failure of closure of the pleuroperitoneal folds during embryologic development. While it is most often diagnosed in neonates and infants, Bochdalek hernias can rarely present in adulthood for the first time. We describe the case of a 42-year-old lady who presented with sudden onset of severe abdominal pain following a Zumba dance session. Her chest radiograph showed an elevated left hemi-diaphragm with visualization of a gastric bubble in the thorax. A computed tomography (CT) scan of the abdomen showed a defect in the left hemi-diaphragm with herniation of the stomach and abdominal viscera through the defect. The patient was taken for diagnostic laparoscopy, and the diaphragmatic defect was repaired with a synthetic mesh. Perioperatively, perforation of the anterior wall of the stomach was noted, and a diagnosis of Bochdalek hernia with gastric strangulation was made. This case demonstrates a rare presentation of Bochdalek hernia in an adult with strangulation and perforation of the stomach. Clinicians need to be aware of this rare but life-threatening clinical entity in order to secure a timely diagnosis and institute appropriate management.

Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

“…4 Presentation in adults commonly occurs due to delayed rupture of peritoneal sac which contains the viscera or plugging of the diaphragmatic defect by a solid organ and subsequent herniation after increased intra-abdominal pressure such as in obesity and pregnancy. 1,4,6,9 Since the hernia commonly results in pulmonary hypoplasia and therefore pulmonary symptoms, it is commonly diagnosed in neonates and infants. 5,8 With the advent of easy access to X-ray and CT imaging, it is considered a very rare occurrence in adults.…”

“…Left-sided herniae include spleen, small intestine, stomach, and colon. 4,6,8 Mortality and morbidity is significantly increased in cases where patients present with incarceration and strangulation of abdominal viscera. 8 In the absence of trauma, chest X-ray readily diagnoses the presence of Bochdalek's hernia usually heralded by the presence of loops of bowel or soft tissue within the chest.…”

“…8 The current mainstay of treatment remains surgical repair due to risk of strangulation and visceral herniation. 2,[6][7][8] Two procedures, namely, the transthroacic and transabodminal approaches have been described in the literature. The transthoracic approach commonly through a lateral thoracotomy is considered relatively easier in comparison to the transabdominal approach.…”

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“…3,5 Overall, 80 to 90% of Bochdalek's herniae commonly present on the left side. 4,6 Right-sided herniae are rare (10% of cases), as the right pleuroperitoneal canal closes earlier and the liver buttresses the right diaphragm. 2,7,8 Complete separation of the thoracic and abdominal cavities occurs by the eighth week of gestation.…”

“…4 Presentation in adults commonly occurs due to delayed rupture of peritoneal sac which contains the viscera or plugging of the diaphragmatic defect by a solid organ and subsequent herniation after increased intra-abdominal pressure such as in obesity and pregnancy. 1,4,6,9 Since the hernia commonly results in pulmonary hypoplasia and therefore pulmonary symptoms, it is commonly diagnosed in neonates and infants. 5,8 With the advent of easy access to X-ray and CT imaging, it is considered a very rare occurrence in adults.…”