An unusual case of dyspnoea in an elderly man

Abstract

Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature. Most adolescent and adult cases are diagnosed incidentally during imaging for upper gastrointestinal symptoms. It is unusual for adults to present with respiratory symptoms. We describe the case of a 71-year-old man who presented with features of left ventricular failure due to an exceptionally large, right sided Bochdalek hernia. This is the oldest clinical presentation of a right sided Bochdalek hernia, which uniquely included trans-diaphragmatic herniation of the pancreas.

Association of intestinal malrotation and Bochdalek hernia in an adult: a case report

“…A failure in this process gives rise to CDH. The BH is a defect in the posterolateral closure of the pleuroperitoneal folds that gives rise to the diaphragm, and has an estimated incidence of 1 in 2000–5000 newborns [ 1 , 2 ]. The true prevalence is hard to estimate but the diagnosis of the condition has increased because of the availability of imaging in the investigation of non-specific symptoms [ 2 ].…”

“…Bochdalek hernia (BH) in adults is extremely rare, with less than 100 published cases in the literature (less than 50 were symptomatic) [ 1 , 2 ]. The clinical presentation with nonspecific gastrointestinal symptoms makes the diagnosis challenging, and so computed tomography (CT) is necessary for an accurate diagnosis.…”

Post-menopausal acquired diaphragmatic herniation in the context of endometriosis

“…CDH can be further classified as Morgagni and the more common Bochdalek hernias (BH). The latter has a left sided preponderance [ 3 ], rarely present in adulthood and are often identified incidentally on imaging [ 4 , 5 ]. BH are caused by incomplete fusion of pleuroperitoneum either posteriorly in the lumbocostal triangles or posterolaterally in the pleuroperitoneal fold.…”

“…BH are caused by incomplete fusion of pleuroperitoneum either posteriorly in the lumbocostal triangles or posterolaterally in the pleuroperitoneal fold. They usually only contain abdominal fat, however larger defects have been shown to contain omentum, bowel, colon, spleen, liver and also the pancreas [ 4 , 6 ]. Majority of BH are detected in utero, or at birth; manifesting as respiratory distress.…”

Laparoscopic repair of an incarcerated Bochdalek hernia in an elderly man

“…The Bochdalek hernia (BH) is a posterior congenital closing defect of the diaphragm, usually seen in infants . BH occurs rarely in adulthood and frequently is incidentally discovered in patients admitted for gastrointestinal or respiratory symptoms . Either in infants or in adults, such hernias can represent a life‐threatening condition .…”