Incarcerated adult Bochdalek hernia with splenic infarction

[Complications of misdiagnosed Bochdalek hernia in adults. Literature review]

AIM OF THE STUDY

To report 3 new cases of complicated Bochdalek hernia (BH) in adulthood and to review the literature about this rare condition.

CASE REPORT

Three adult patients were operated on for a BH undiagnosed until occurrence of acute complication. The first patient, 27 years-old, had small bowel obstruction and the diagnosis of BH, unrecognized on chest X-ray, was established on barium meal and CT scan. The second patient, 38 years-old, had epigastric pain and gastric obstruction: diagnosis of BH, unrecognized at a previous laparotomy, was established on CT scan and barium enema. The third patient, 88 years-old, had respiratory failure and gastric obstruction: diagnosis of BH, unrecognized on chest X-ray, was established on CT scan. The 3 patients were operated on through laparotomy (n = 2) ou thoracotomy (n = 1) with one post-operative death.

DISCUSSION

In adulthood, BH can remain asymptomatic for a long time before occurrence of a acute digestive or respiratory complication. Chest X-ray can be normal or misinterpreted. CT scan seems to be the most reliable examination to diagnose BH.

CONCLUSION

In adulthood, diagnosis of BH should be evocated in case of respiratory or upper digestive symptoms.

[Intrathoracic volvulus of the spleen revealing left posterolateral diaphragmatic hernia]

BACKGROUND

Late-recognized congenital left diaphragmatic hernia may have a bad prognosis when it is revealed by perforation or volvulus of the herniated viscera.

CASE REPORT

A 20 month-old boy was admitted for vomiting and abdominal pain. X-rays showed left diaphragmatic hernia and the patient was operated on with the diagnosis of volvulus of the stomach. Surgery showed hernia through the posterolateral segments of the diaphragm with spleen volvulus into the sac, requiring splenectomy before reduction of the hernia and closure of the diaphragmatic defect.

CONCLUSION

This is the fifth report of ectopic intrathoracic spleen with volvulus revealing congenital left diaphragmatic hernia.

Bilateral large Bochdalek hernias in an adult. CT demonstration

Bochdalek hernia is a congenital posterior diaphragmatic defect resulting from failure of the retroperitoneal canal membrane to fuse with the dorsal esophageal mesentery and the body wall. A recent computed tomography study indicated that these defects frequently can be identified on routine chest and abdominal images, and classified them as small, medium, and large, the large ones being identifiable on five or more contiguous axial scans consisting of 1-cm-thick sections. Although the overall prevalence of Bochdalek hernias is 6%, and that of bilateral hernias is 0.9%, to date only a few patients with unilateral or bilateral large hernias have been reported. This article describes an adult with asymptomatic, bilateral, large Bochdalek defects containing herniated retroperitoneal fat.

Late-onset Bochdalek hernia with a rare postoperative complication: case report

We report a case of a 7-year-old-girl with a late-presenting Bochdalek hernia. The postoperative course was complicated by splenic torsion and subsequent total splenic infarction. Total splenic infarction due to splenic torsion has been reported in children with "wandering spleen" and in incarcerated Bochdalek hernias, but to our knowledge, not as a postoperative complication of Bochdalek hernia repair.

Adult Bochdalek hernia--clinical features, management and results of treatment

We herein present 2 cases of adult Bochdalek hernia. Only a total of 51 such cases have been reported since 1958, and we have reviewed these cases and discussed their clinical features, operative treatment and final outcome. The majority of these patients presented as acute surgical emergencies and a lack of awareness of this condition lead to an incorrect diagnosis in 38 per cent. Intestinal obstruction with left lung signs and a non-distended abdomen in an adult patient should arouse suspicion of this condition. A plain X-ray of the chest and contrast studies of the gastrointestinal tract are necessary to confirm the diagnosis. A previous normal chest X-ray does not rule out a diaphragmatic hernia, as the defect may be plugged by the spleen or by the presence of a confining sac. The high incidence of strangulation emphasises the need for early diagnosis and prompt operative management which gives highly satisfactory results.

Acute herniation through a posterolateral diaphragmatic (Bochdalek) hernia in an adult

Acute herniation through a posterolateral diaphragmatic defect is rare. A case is presented in which herniation took place after the sudden inversion of a 16-year old youth. Its aetiology, presentation, diagnosis and treatment are discussed.