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Large Right Congenital Diaphragmatic (Bochdalek) Hernia: An Incidental Finding in an Aged Patient with Acute Intestinal Obstruction

Accessible online at: www.karger.com/journals/dsu An 88-year-old woman was presented to our department with a 4-day history of intestinal obstruction (nausea/vomiting, abdominal distension, and constipation). Her medical history included appendectomy performed 8 years before and coronary artery disease. Physical examination revealed a small, nontender, and easily reducible umbilical hernia and a marked abdominal distension. Abdominal computed tomography revealed a large, congenital, right posterolateral diaphragmatic hernia through the foramen of Bochdalek, containing parts of the liver and the kidney and the hepatic flexure of the colon (fig. 1). However, computed tomography suggested that the cause of the intestinal obstruction was at the distal ileum, in the lower abdomen, since the intestinal dilatation was abruptly stopped at this point and since terminal ileum and right colon were without distension (fig. 2). At surgery, a fibrous adhesion (probably because of the previous appendectomy) was found to obstruct the terminal ileum. An adhesiolysis was performed, and, since at this point the lumen of the small intestine was markedly narrowed (probably as a result of the pressure from the fibrous band), a side-to-side enteroenteroanastomosis was performed. Based on the patient’s age and history, the Bochdalek right congenital hernia was considered an incidental finding. The postoperative course was uneventful, and the patient is well 1 month after surgery.