Bochdalek Hernia in Adulthood: A Review and an Autopsy Case Report

Abstract

Bochdalek hernia is rare in adulthood with fewer than 100 cases having been reported in the world literature. We present a delayed case of Bochdalek hernia in an adult leading to sudden death, first diagnosed at medicolegal autopsy.

Bilateral Bochdalek Hernias Presenting as Respiratory Failure in an Elderly Patient

“…2,6,[8][9][10][11] In the rare cases in which symptoms do occur, especially in adults, a triggering event is usually present, such as trauma, exercise, sexual intercourse, anxiety, or another factor associated with increased metabolic demand or thoracic and abdominal pressure, such as pregnancy, labor, large food ingestion, and even sneezing or coughing. 1 To date only 4 cases of bilateral Bochdalek hernia in adults have been reported, [12][13][14][15] and only 2 cases have been reported in octogenarians, with only one being bilateral. Our patient highlights Bochdalek hernia as an unusual cause of respiratory failure in an octogenarian.…”

“…This anomaly was first described in 1848, although it may have been discovered as early as the 17th century. 1,2 This type of hernia allows the passage of gastrointestinal structures into the thoracic cavity, which limits lung expansion, functional capacity, and ventilatory performance. Bochdalek hernia is common in neonates and rare in adults, especially in the elderly.…”

Congenital Bochdalek’s Diaphragmatic Hernia

“…The condition is produced by a hole in the diaphragm, which allows the abdominal contents to protrude into the chest cavity. While Bochdalek's CDH occurs more in infants and mostly located on the left side of the diaphragm, Morgagni's type usually occur on the right and common in adults 1,3,4 . Diagnosis of CDH may be incidental or symptomatic.…”

“…C ongenital diaphragmatic hernias (CDH) resulting from developmental failure of posterolateral diaphragmatic foramina to fuse properly are rare and were fi rst described by Bochdalek in 1848 1 . Although the prevalence of Bochdalek's hernia remains unknown, estimates ranging from as low as 1 in 2000-7000 based on autopsies to as high as 6% based on CT examinations [1][2][3] .…”

“…Although the prevalence of Bochdalek's hernia remains unknown, estimates ranging from as low as 1 in 2000-7000 based on autopsies to as high as 6% based on CT examinations [1][2][3] . The condition is produced by a hole in the diaphragm, which allows the abdominal contents to protrude into the chest cavity.…”