Late-onset congenital diaphragmatic hernia: A case report

Abstract

INTRODUCTIONA Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiafragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure.PRESENTATION OF CASEIn this paper we present a 35 year old man with a 5-year history of episodes of severe dyspnea who arrived to the emergency room, during his medical work-up we incidentally found an intrathoracic gastric bubble, a laparoscopy was performed, founding a necrotic stomach and for defect correction.DISCUSSIONThis pathology is infrequent in adults, among this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity.CONCLUSIONDiaphragmatic hernias are rare among adult population, and they are usually asymptomatic, in this case we presented a symptomatic patient, diagnosed with a chest X-ray and treated surgically. The surgical approach for the resolution of this pathology is variable and it depends on the presence and severity of visceral complications.

A Rare Cause of Haemorrhage in the Upper Gastrointestinal System Bochdalek Hernia

“…Recurrent pulmonary infections, dyspnoea, wheezing, chest pain, recurrent abdominal pain, dysphagia, lack of appetite, nausea, vomiting and diarrhoea have been reported in the literature. Gastrointestinal haemorrhage and anaemia may develop as a result of diaphragmatic hernia-related gastric volvulus (4,5,8,9). Gastric volvulus-related upper gastrointestinal haemorrhage was present in our case.…”

“…It occurs as a result of failure of the pleuroperitoneal channel to close completely at weeks 8-10 of pregnancy. It is generally (80-90% of cases) left posterolaterally localized and is twice as common in males (1,7,8). Late-onset Bochdalek hernia is generally seen in right-sided defects (5).…”

“…Emergency CT can be performed when accompanying pathologies are suspected and when the intestinal loops are strangulated. Direct abdominal radiography can be important in the diagnosis of patients with vomiting of uncertain cause (4,5,8,10,11). Indeed, we learned from her history that she had been monitored for three days in another centre because of vomiting.…”

Bochdalek Hernia with Gastric Necrosis in a 54-Year-Old Man, Case Report and Review of the Literature

“…Asymptomatic cases account for 14% [4]. In the case of incarcerated organs the most frequently displaced include stomach followed by colon, spleen and small bowel [1].…”

“…Bochdalek hernia was first described by Vincent Alexander Bochdalek in 1848, described as a posterolateral diaphragmatic hernia [1]. The incidence is about 1 in 2200 to 12,500 live births and usually is presented in newborns with respiratory insufficiency due to pulmonary hypoplasia requiring immediately surgery with a high morbidity and mortality [2].…”