Rare case of Bochdalek hernia in a patient with acute chest pain and dyspnea on exertion

China: Bochdalek hernia (BH) is characterized by diaphragmatic abnormalities in infants with cyanosis, tachycardia, and asymmetric growth in the chest cavity.

A rare case of Bochdalek hernia associated with developmental abnormalities in an adult who exhibited acute chest pain and dyspnea on exertion was presented by Dr. Yi-Min Gu and team, the case study highlighted the importance of the differential diagnosis of acute left-sided chest pain and antenatal examination. The findings of the case study are published in BMC Surgery.

Symptomatic BH is rare in adults and is found mainly in infants in respiratory distress. Reduction of the herniated content back into the peritoneal cavity, repair of the hernia, and relief of the intestinal obstruction were the important objectives of the case study.

The case study reported a rare case of BH in a 19-year-old woman who showed acute paroxysmal left chest pain radiating to the epigastrium of 4 days duration. She had a 10-year history of exertional dyspnea that was aggravated in the supine position, but no history of the chest or abdominal trauma was reported. She was said to be misdiagnosed with a pulmonary abscess at another hospital, and the oral antibiotic treatment was ineffectual. Clinical examination on admission to the hospital revealed bowel sounds and decreased air entry in the left chest and that the abdomen appeared to be scaphoid. No obstructive gastrointestinal symptoms were observed. An X-ray revealed herniated loops of both the small and large intestines in the left hemithorax, which produced multiple lucent shadows and severely reduced lung space. Computed tomography (CT) images showed that the bowel loops and fat passed through a defect in the posterolateral left hemidiaphragm.

A left posterolateral thoracotomy was performed through the sixth intercostal space. The diaphragmatic defect was found along with herniation of the jejunum, ileum, ileocecal junction, appendix, and ascending and transverse colon, and pulmonary hypoplasia was seen in the left lower lung lobe. The surgeons performed an adhesion separation around the foramen and within the pleural cavity. A laparotomy was subsequently performed through a median incision. During the operation, anomalies were found in intestinal rotation and fixation, and the total length of the jejunoileal was measured as 750 cm. The herniated viscera were returned to the abdominal cavity. A sublay patch repair of the left posterolateral diaphragmatic hernia using a Dacron patch was performed, however, the postoperative period was a rough time after a month follow up the surgery was successful and the patient was relieved of pain.

Dr. Yi-Min Gu and the team conveyed their surgery was successful in effectively treating BH they stated that the patient was initially misdiagnosed with a pulmonary abscess. After undergoing a mesh-based patch repair, the patient's pain and dyspnea were relieved, and good therapeutic outcomes were achieved.

Reference

Gu, YM., Li, XY., Wang, WP. et al. A rare Bochdalek hernia in an adult: a case report. BMC Surg 21, 364 (2021). https://doi.org/10.1186/s12893-021-01357-2