Bochdalek hernias are congenital diaphragmatic defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. We describe our experience with this rare entity. A retrospective chart review was performed on a single patient for data collection purposes. The patient is a morbidly obese year-old female who presented with epigastric pain and diffuse abdominal tenderness.
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Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Correspondence: Atef Mejri, Bousalem, Tunisia e-mail: atef. Bochdalek hernias in adulthood are rare. Symptomatic Bochdalek hernias in adults are rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency. Here, we report a case of a year-old woman diagnosed with epigastric pain, cough, vomiting since 2 weeks and shortness of breath.
Complicated Bochdalek hernia was an incidental finding, diagnosed by chest radiograph, computed tomography CT , and barium swallow study.
Stomach was within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. The patient was prepared for the laparoscopic surgical repair, to close the defect. The patient recovered with accepted general condition and was discharged 9 days later. Diagnoses of Bochdalek hernias in adulthood are challenging.
However, although rare, this possibility should be kept in mind to avoid fatal complications. Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. Organoaxial and mesentericoaxial volvulus are distinguished according to the direction of rotation.
The most common cause of gastric volvulus is hiatal hernia. Gastric volvulus requires surgical treatment, specifically volvulus reduction, reintegration of the stomach into the abdominal and correction of causal factors. We have experienced a Tunisian female patient, year-old, not hypertensive, not diabetic, family history and past history were irrelevant.
She did not report any reflux symptoms and she denied any use of nonsteroid anti-inflammatory drugs. There was no history of trauma. That patient complained about epigastric pain associated with early satiety and postprandial vomiting for 2 weeks and a moderate form dyspnea. Her physical examination did not reveal any significant abnormality. When a nasogastric tube was placed, it could not be advanced into the stomach.
A postero—anterior chest x-ray Figure 1 showed an air bubble with air-fluid level in her left thoracic cavity, and a diaphragmatic hernia was initially suspected. A barium swallow study Figure 2 confirmed a diagnosis of diaphragmatic hernia with intrathoracic organo-axial gastric volvulus.
CT of chest, abdomen, and pelvis with intravenous contrast showed the presence of a left-sided postero-lateral diaphragmatic defect with herniation of the stomach into the thorax. This case study was carried out in Tunisia. The Ethical Committee, Tunis faculty of Medicine, approved the present study and the patient approved with a written consent prior to the surgery.
It is a birth defect that has remained asymptomatic for 56 years. The diagnosis is made at the stage of acute gastric volvulus on diaphragmatic hernia, which is life threatening. The patient was prepared for laparoscopic diaphragmatic repair.
Preoperative assessment included routine investigations. A laparoscopic approach was performed. There was a 10 cm defect Figure 3 in the left hemi-diaphragm through which the stomach protruded. Dissection of the hernia looks risky there were multiple adhesions. We convert to the laparotomic approach through an upper midline incision. The content was reduced; the stomach was congested but viable Figure 3.
We use 2 to 0 prolene to bridge the diaphragmatic defect. The patient made an uneventful postoperative recovery and was discharged 9 days later. The foramen of Bochdalek is a 2 to 3 cm opening in the postero lateral aspect of the fetal diaphragm, through which there is communication between the pleural and peritoneal cavities.
In patients with congenital diaphragmatic hernia, these ligaments may be elongated or absent. The most common cause of gastric volvulus is hiatal hernia, but the principal predisposing factor is ligamentous laxity. Gastric volvulus is most often found in the elderly, with a peak incidence around Moreover a barium swallow is essential to confirm the diagnosis. Nonetheless, a CT now provides a comprehensive description of the thoracic lesion, including stomach vitality.
The principles of surgical treatment include detorsion of the volvulus, reduction of the herniated contents, closure of the diaphragmatic defect, and fixation of the stomach to the anterior abdominal wall. The particular educational message we obtained is to suspect congenital diaphragmatic hernia even in an adult patient. Additionally, surgical treatment is necessary and it can be done with laparoscopic approach. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Advanced Search. Toggle navigation. Subscribe Register Login. December - Volume 94 - Issue Previous Article Next Article. Article as EPUB. Your Name: optional. Your Email:. Colleague's Email:. Separate multiple e-mails with a ;. Thought you might appreciate this item s I saw at Medicine. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Research Article: Clinical Case Report. The authors have no conflicts of interest to disclose.
Medicine: December - Volume 94 - Issue 51 - p e A Barium Swallow Study before reparation. B Barium Swallow Study 1 month after reparation. A Postero—lateral defect in the left diaphragm. B Area of strangulation. Adult Bochdalek hernia with bowel incarceration. J Chin Med Assoc ; — Heykal Bedioui, Zoubeir Bensafta. Presse Med ; e67—e Cited Here. Intrathoracic caecal perforation presenting as dyspnea. Case Rep Med ; —4. World J Emerg Surg ; Late presentation of Bochdalek hernia: our experience and review of the literature.
Isr J Med Sci ; — Cited Here PubMed. Folia Morphologica ; Sinwa PD. Gastric mesenteroaxial volvulus with partial eventration of left hemidiaphragm: a rare case report.
Int J Surg Case Rep ; — Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. J Pediatric Surg ; E35—E Borchardt M. Zur pathologie und therapie des magen volvulus. Arch Klin Chir ; — Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia.
Pediatr Surg Int ; — Acute gastric volvulus: a rare but real surgical emergency. Am J Emerg Med ; e5—e7.
Imaging description A Bochdalek hernia is a defect of the posterior hemidiaphragm with protrusion of abdominal content, usually fat, into the thorax . It may occur on either side, but is more common on the left side due to a protective barrier effect of the liver [1, 2]. CT typically demonstrates the diaphragmatic defect with abdominal fat or omentum protruding through the defect [1—4] Figure Less commonly, retroperitoneal or intraperitoneal organs may herniate through the defect  Figures The kidney is the most common organ to herniate through the defect, followed by the spleen .
Bilateral Bochdalek Hernias Presenting as Respiratory Failure in an Elderly Patient
Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Correspondence: Atef Mejri, Bousalem, Tunisia e-mail: atef.