Bochdalek’s hernia in an adult with colon necrosis

Abstract

The improper fusion of the posterolateral foramina of the diaphragm was first described by Bochdalek in 1848. The true incidence of this congenital anomaly ranges from 1/7,000 to 6%. Although it is a well-known neonatal disease, it can also be diagnosed incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek's hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some cases. We herein report a case of a 21-year-old man with a left-sided Bochdalek's hernia which led to total necrosis of the transverse colon. Following resection and colocolonic anastomosis, the defect on the diaphragm was repaired. After an uneventful recovery period, he was discharged from the hospital on the 10th postoperative day. Being aware of this rarely encountered disease and of the factors for early diagnosis is of utmost importance to decrease mortality and morbidity.

Thoracoscopic approach to congenital diaphragmatic hernias in adults: Southampton approach and review of the literature

“…As the right pleuroperitoneal canal closes earlier than the left, a Bochdalek hernia predominantly occurs on the left chest (80% of cases) (5). A hernia sac has been reported to be present in 10 to 38% of cases (10). There was no hernia sac in our two cases and this is consistent with other reports in the literature (11-13).…”

“…Herniating colon, small intestines, liver, kidney, gall bladder, spleen, pancreas, stomach, appendix and omentum have all have been previously reported. Acute presentation can be life threatening, especially with threatened bowel in the chest (6,10,18). The respiratory symptoms are related to the 'space occupying lesion' in the chest, namely, shortness of breath on exertion.…”

Outcome of diaphragmatic herniation and eventration repair in adults

“…The commonest symptom is found to be shortness of breath in almost all studies which is a finding similar to ours. However the symptoms can be vague and nonspecific, including chest pains, dyspnoea, and gastrointestinal complaints 12 Omentum is the most common content in the hernial sac 2 but we found stomach and omentum are most common content in the hernial sac. The diagnosis can be achieved through a chest X-ray, CT scan, Magnetic Resonance Imaging or an upper gastrointestinal series.…”

Bochdalek Hernia with Adult Diaphragmatic Agenesis

“…Abdominal organların eşlik ettiği büyük hernilerde komplikasyon gelişme riski yüksektir. Bu vakalarda cerrahi tedavi düşünülmeli-dir [7]. Cerrahi girişim yeri olarak torakotomi iyi bir tercihtir fakat barsaklarda malrotasyon varsa o zaman abdominal yaklaşım faydalı olabilir.…”