2019, Number 3
PDF size: 354.05 Kb.
ABSTRACTIntroduction: The Bochdalek hernia is the most common congenital diaphragmatic defect. There are less than 200 cases reported in adults, which represent about 5% of the cases in medical literature; therefore, its diagnosis is hard to make.
Clinic case: A 23-year-old female patient who was referred from her medical institution with a diagnosis of spontaneous pneumothorax after suffering from left hemithorax pain and dyspnea 24 hours after undergoing labor. At the emergency room, an endopleural tube was placed, but since there was no pulmonary re-expansion, an unenhanced CT scan was performed and a medical petition was requested to the radiology and surgery department. A diagnosis of incarcerated Bochdalek hernia was made and the patient underwent an emergency laparotomy with primary closure. She recovered successfully and was discharged from hospital on the fourth postoperative day.
Discussion: Bochdalek hernia is misdiagnosed in about 38% of the cases because of its low incidence and the different types of clinical presentations. In this case, the main diagnosis was initially a spontaneous pneumothorax with endopleural seal placement, which could have caused several complications.
Conclusion: The Bochdalek hernia represents a diagnostic challenge because delaying its management is associated with high-risk complications.
Oneil Machado N. Laparoscopic Repair Of Bochdalek Diaphragmatic Hernia in Adults. N Am J Med Sci. 2016;8(2):65-74.
Schumacher L, Gilbert S. Congenital Diaphragmatic Hernia in the Adult. Thorac Surg Clin. 2009;19:469-72.
Hamid KS, Rai SS, Rodríguez JA. Symtomatic Bochdalek Hernia in an Adult. JSLS. 2010 Apr-Jun;14(2):279-81. doi: 10.4293/108680810X12785289144719
Matsudera S, Nakajima M, Takahashi M, Muroi H, Kikuchi M, Shida Y et al. Laparoscopic surgery for a Bochdalek hernia triggered by pregnancy in an adult woman: A case report. Int J Surg Case Rep. 2018;48:10-5. doi: 10.1016/j. ijscr.2018.04.028
Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg. 2017 May 18;12:23. doi: 10.1186/s13017-017-0134- 5. eCollection 2017.
Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012 Mar-Apr;32(2):E51-70.
Rodríguez Molina A, Rodríguez Pavón C, González Fernández M, Fernández-Crehuet Serrano C, Atencia Ballesteros M, Tapia Guerrero A; Malaga/ES. Hernias diafragmáticas en Urgencias: complicaciones agudas y revisión de casos. SERAM. 2014 / S-0740.
Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR Am J Roentgenol. 2001 Aug;177(2):363-6.