Late-onset Bochdalek's hernia with obstruction: radiographic spectrum of presentation

Three patients with late-onset Bochdalek's hernia are presented. All three had obstruction of the herniated bowel and, in two patients, this was complicated by strangulation and necrosis. The spectrum of roentgenographic manifestation included obvious findings of bowel in the chest in one patient; in another, the findings simulated pneumonia associated with reflex bowel ileus in the abdomen. The third patient had a massive pleural effusion, with what appeared to be associated bowel ileus. In spite of the misleading presentation it is imperative that the correct diagnosis be made early since the incidence of strangulation and severe morbidity is high.