A RARE CASE OF STRANGULATED RIGHT‑SIDED BOCHDALEK HERNIA IN ADULT rita.banza@chleiria.min-saude.pt

PE092

A RARE CASE OF STRANGULATED RIGHT‑SIDED BOCHDALEK HERNIA IN ADULT

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João Simões joao.m.simoes@ulsrl.min-saude.pt Unidade Local de Saúde da Região de Leiria Cirurgia Geral Leiria Portugal

Sandra Ferraz sandra.ferraz@ulsrl.min-saude.pt Unidade Local de Saúde da Região de Leiria Cirurgia Geral Leiria Portugal

Miguel Coelho dos Santos Miguel.Coelho@ulsrl.min-saude.pt Unidade Local de Saúde da Região de Leiria Cirurgia Geral Leiria Portugal

 

Portugal

Poster Exhibition only

Bochdalek hernia (BH) is a type of congenital diaphragmatic hernia characterized by a defect in the posterolateral segment of the diaphragm. It is usually diagnosed in newborns and infants. In adults it is very rare and may be diagnosed incidentally through imaging studies or present with acute symptoms due to complications arising from the herniation of abdominal viscera.

This report describes a rare case of BH in adult. A 45-year-old woman presented with acute right-sided chest pain radiating to the dorsal region after an episode of singultus. She denied any respiratory or gastrointestinal symptoms and history of thoracoabdominal trauma. Clinical examination on admission revealed tachycardia, mild hypoxia and abdominal pain in upper quadrants without tenderness. Computed tomography revealed defect in the posterolateral segment of right hemidiaphragm with herniated bowel in right hemithorax. The patient underwent urgent laparoscopic exploration, which identified a strangulated right-sided BH containing the ileocecal junction. Through median laparotomy, surgical procedures included reduction of herniated viscera, ileocecal resection with primary anastomosis, primary repair of the diaphragmatic defect and placement of a thoracic drain.

The postoperative course was uneventful and the patient was discharged on the 6th postoperative day.

In adults, HB occur predominantly in women and mainly during the sixth decade of life. The recommended treatment is surgery with reduction of herniated content and repair of the hernia, to avoid any complications, like strangulation or cardiorespiratory complications. A high index of suspicion, accurate diagnosis and prompt treatment are essential for a favourable outcome.