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Strangulated Bochdalek Hernia: A Rare Cause of Bowel Obstruction in Adult

Bochdalek hernia is a rare form of diaphragmatic hernia which is infrequently diagnosed in adults and strangulation is the more frequent revelation mode. We report a case of Bochdalek strangulated hernia complicated with bowel obstruction in a 42-years-old female patient. She underwent laparotomy allowing the reduction of the content of hernia in abdomen with primary closure of the defect. The outcome was uneventful. Keyswords Bochdalek hernia, Strangulated hernia, Adult, Computed tomography, Laparoscopy, Thoracoscopy. Introduction Bodchalek hernia is a rare pathological entity among diaphragmatic hernias. It is the result of incomplete closure of diaphragmatic postero-lateral parts during embryogenesis between the 9th and 10th week of amenorrhea [1,2]. It is a congenital defect often early diagnosed in neonates. Adulthood diagnosis is rare. Given the rarity and non-specificity of symptoms of Bochdalek hernia in adults, the diagnosis is difficult and delayed. Consequently, in most cases, Bochdalek hernia is diagnosed after complication onset [1,2]. The objective of this work is to report a case of right strangulated Bochdaleck hernia in a 42-year-old female patient admitted to regional hospital of Metz-Thionville and to review scientific literature. Case report A 42-year-old female patient without relevant medical history was admitted for dyspnea, abdominal pain, vomiting and gas and feces absence since a few hours before admission. Upon admission, clinical examination found apyrexia, good general condition, abdominal distension, painful abdomen, free hernial orifices, superficial polypnea, thorax with normal morphology and presence of breath sounds in the right hemithorax. Further clinical examination was without findings. Face to this clinical picture, acute intestinal obstruction, pleuropneumopathy, strangulated hiatal hernia and pulmonary embolism were evoked as diagnosis hypothesis. Thoraco-abdominal CT scan showed right strangulated diaphragmatic hernia (Figure 1). We decided to perform surgery. Due to the caecal distension, we performed laparotomy Emergency exploratory laparotomy found right colon, caecum and appendix sliding up into the thorax through the right postero-lateral defect (Figure 2). The diagnosis of strangulated right Bochdalek hernia was confirmed. Intestinal loops reduction was performed with difficulty needing to cut the border of diaphragmatic defect. The intestinal loops were healthy but the appendix was ischemic. A diaphragmatique primary closure and appendectomy were performed. A right thoracic drain was placed. Outcome of surgery was simple. At the follow-up visit after 1 month, the patient clinical condition was satisfying with a normal control thoraco-abdominal CT scan (Figure 3).