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Acute dyspnoea due to an incarcerated right-sided Bochdalek's hernia
D O Kavanagh1, R S Ryan, R Waldron
1Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Rochester, USA. dara_kav@hotmail.com
Abstract:
We present the case of a 76-year-old man with a right-sided Bochdalek hernia, admitted acutely with dyspnoea, abdominal distension and constipation. A chest radiograph and computed tomogram of the abdomen revealed marked elevation of the right hemidiaphragm caused by herniation of the colon. At laparotomy, strangulation of a portion of transverse colon was identified at the site of the foramen of Bochdalek. The contents of the hernia were reduced and a primary repair of the hernial orifice was performed. The segment of necrosed colon was resected and an end-to-end handsewn anastomosis was constructed. A symptomatic Bochdalek hernia typically presents as a cardiorespiratory emergency in the neonatal period. It can remain silent and present in adulthood with chronic gastro-intestinal or respiratory symptoms. Occasionally it presents with acute dyspnoea or abdominal pain. Early detection and intervention is of the utmost importance to decrease related morbidity and mortality in adults.
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