Right-Sided Bochdalek Hernia with Cecum Perforation

Abstract

Background: A Bochdalek hernia is one of the most frequently occurring congenital diaphragmatic hernias, and it occurs in 1 out of 2,500 births. Clinical cases of adults with symptomatic Bochdalek hernias are very rare. We describe a patient with an incarcerated Bochdalek hernia who underwent emergency surgery and presented with a recurrence after three years. Comparable cases in the literature were reviewed. Case Presentation: A 56-year-old woman presented to the emergency department with acute dyspnea and pain in the epigastrium shortly after gastroscopy. A CT scan showed right sided intrathoracic herniation of the ascending colon and signs of perforation of a hollow viscus. During the operation, a suture repair of a cecal perforation as well as of a diagrammatic lesion was performed. The thorax and abdomen were lavaged and drained. The postoperative course was uneventful. After 3 years, the patient presented with colic pain in the upper abdominal quadrants. A small recurrence of the Bochdalek hernia was observed on a computed tomography scan and was managed with watchful waiting. A systematic search of comparable acute cases of Bochdalek hernias was performed. Conclusion: An incarcerated right colon with a perforation in a Bochdalek hernia is extremely rare; only 11 comparable cases of right sided Bochdalek hernia with acute symptoms are described in the literature. Recurrent Bochdalek hernias are even rarer. As a delay in the diagnosis or a missed diagnosis can ultimately lead to death, adequate imaging is warranted when considering a recurrence of a Bochdalek hernia.