Pleuroperitoneal Hernia in an Adult Patient

Pleuroperitoneal hernia is the most frequent diaphragmatic congenital hernia, appearing in 1 in 3,000 births. This diaphragmatic defect is located on the left side in 80% to 90% of cases. Pleuroperitoneal hernia is usually diagnosed in the first 8 weeks of life due to respiratory compromise caused by the herniation of abdominal organs into the thoracic cavity; therefore, adult presentation is a rare condition.

We present a case of a 55-year-old man with a history of long-term cigarette smoking who arrived at the emergency department with a chronic cough. Initially, the patient was misdiagnosed as exacerbated chronic obstructive pulmonary disease, for which a contrast chest computed tomography was performed showing a left posterior pleuroperitoneal hernia that contained the upper pole of the ipsilateral kidney and adrenal fatty tissue. The surgical approach chosen in this case was through laparoscopy, resulting in an appropriate postsurgical evolution, for which the patient was discharged with a general surgery control appointment. The patient was evaluated 1 week and 1 month after surgery, showing a normal physical examination and resolution of the respiratory symptoms.

Pleuroperitoneal hernia symptoms in adults most commonly affect the gastrointestinal and the respiratory tract. The diagnosis is performed by computed tomography or magnetic resonance imaging, in which a diaphragmatic defect can be seen. Pleuroperitoneal hernia complications must always be discarded by computed tomography and transthoracic echocardiogram. The treatment is based on surgical repair of the diaphragmatic defect. The surgical approach chosen may vary according to the surgeon's expertise.