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Congenital right bochdalek hernia presenting as emergency in old age: a case report

Rajgopal Shenoy K1, Goonj Johri1

  • 1Department of Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104 India.

The Indian Journal of Surgery
|January 16, 2014
PubMed

Insights

This case study highlights a rare right-sided Bochdalek hernia, a type of congenital diaphragmatic hernia, presenting in an elderly male after 60 asymptomatic years. The patient successfully recovered after emergency surgery for small bowel herniation.

Area of Science:

  • Medical Case Study
  • Surgical Gastroenterology
  • Thoracic Surgery

Background:

  • Congenital diaphragmatic hernias (CDHs) can manifest beyond the neonatal period.
  • Posterolateral Bochdalek hernias are the most common type, predominantly occurring on the left side (85%).
  • Right-sided Bochdalek hernias are less common, accounting for approximately 13% of cases.

Purpose of the Study:

  • To report a rare case of a right-sided Bochdalek hernia in an elderly male.
  • To illustrate the delayed presentation and diagnostic process of a congenital diaphragmatic hernia.
  • To emphasize the importance of considering CDH in adult patients with abdominal discomfort.

Main Methods:

  • Case presentation of an asymptomatic elderly male with delayed presentation of a right-sided Bochdalek hernia.
  • Diagnostic imaging including ultrasound and contrast CT scan to confirm small bowel herniation into the right hemithorax.
  • Emergency surgical intervention for suspected closed-loop obstruction.

Main Results:

  • The patient presented with vague right upper abdominal discomfort.
  • Imaging confirmed herniation of small bowel loops into the right thorax with signs suggestive of obstruction.
  • Successful emergency surgery and uneventful recovery.

Conclusions:

  • Right-sided Bochdalek hernias can remain asymptomatic for decades.
  • Congenital diaphragmatic hernias should be considered in the differential diagnosis of abdominal discomfort in adults.
  • Prompt surgical management is crucial for symptomatic CDH with potential complications.

Keywords:
AdultsCongenital diaphragmatic herniaEmergency

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