A successfully operated case of a rare type of incarcerated diaphragmatic hernia

The authors present a successfully operated case of a Bochdalek hernia in an adult. This type of diaphragmatic hernia mostly occurs in infants, it is a rarity in adults. A 41-year-old woman was admitted with emergency because of right upper abdominal and dorsal pain. In her previous history, there was not any trauma or known congenital diaphragmatic defect. Her laboratory tests were normal except for anaemia. Chest X-ray was negative, abdominal X-ray showed dilated bowels between the liver and the diaphragm with suspicion of free abdominal air. Chest and abdominal computed tomography scan revealed a right dorsal diaphragmatic hernia with an incarcerated part of small intestine. Physical examination revealed no abdominal tenderness, but she had severe dorsal and upper abdominal pain. She underwent an urgent operation. An abdominal approach (upper horizontal laparotomy) was performed. No hernia sac was present. Approximately 40 cm incarcerated ileum was removed from the thoracic cavity. Due to the immediate expansion of the lungs, thoracostomy tube was not inserted. The diaphragm was sutured, the necrotised small bowel was resected and an end-to-end anastomosis was performed. During the post-operative period, small pneumothorax occurred, but no intervention was needed, it healed spontaneously. The patient was discharged on the 10th day after operation.