Medical & Clinical Reviews

Hernia de Bochdalek: A Challenging Diagnosis

Diaphragmatic hernias are defined as a transposition of abdominal organs into the thoracic cavity through a defect in the phrenic muscle. They can be classified as congenital, acquired, or post traumatic. The Bochdalek hernia is congenital, it is produced by an alteration in the embryological development of the diaphragm, causing a zone of anatomical weakness that allows the protrusion of intraabdominal organs into the thoracic cavity. The prevalence of the Bochdalek hernia is 1 in 2,200 births and is located on the left side 80%-90% of the time, only 5%-10% remain undetectable during childhood. Less than 100 cases have been reported in adults. In Honduras there have been few cases reported in pediatrics, and none in adults. We present the case of a 38-year-old patient that seeks at the Hospital Escuela Universitario in Tegucigalpa, Honduras, due to abdominal pain located in the left iliac fosse that irradiates to the right flank and hypochondrium over the past two months, accompanied by dyspnea and paroxistic episodes of cough. At thoracic auscultation wheezing was found with predominance in the left lung, with hypoventilation and the presence of intestinal sounds. A thoracoabdominal tomography with contrast was performed, finding the presence of a diaphragmatic hernia occupying the whole left hemithorax, including the spleen, colon and stomach. The data is corroborated by a diagnostic laparoscopy, but because the organs could not be reduced to the abdominal cavity a laparotomy was performed. The findings correspond to the organs that are commonly herniated in the left Bochdalek hernia. After the laparotomy the patient had a satisfying progress, with subsequent hospital discharge. It is important to have a timely diagnosis and adequate treatment for this type of hernia to prevent complications that could compromise the life of the patient.

Author(s):

Campos-Sanchez Eduardo Jose, Mejia-Martinez Lessdy Aarely, Sierra-Aguilar S Ivana, Avila-De La Puente Claudia and Juan Francisco Ayestas

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