Congenital diaphragmatic hernia: presentations and problems in the adult

Adult Bochdalek hernia simulating left pleural effusion: a review and a case report

The authors present a rare case of congenital diaphragmatic Bochdalek hernia in an adult stimulating left pleural effusion. The diagnosis of left pleural effusion was made on the basis of conventional chest X-ray and ultrasonography. The definitive diagnosis of Bochdalek hernia was made by left video-assisted thoracoscopy. The patient was successfully treated operatively by conventional surgery--a combination of left thoracotomy and median laparotomy. The reported case supported the view that Bochdalek hernia in adults presents usually with atypical chronic abdominal and respiratory symptoms. Surgical treatment should best be performed, according to the authors, by competent surgeons with good command of both the thoracic and abdominal approaches to the diaphragm.

[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.

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.

Cribriform diaphragm: a variant of congenital diaphragmatic herniation. A case report

Herniation through a "cribriform" diaphragm was incidentally detected in a 65-year-old woman. Liver tissue protruding into the right hemithorax showed signs of strangulation. The defects were surgically corrected. The condition presumably was an extremely rare variant of congenital diaphragmatic hernia.