Kosin Med J.  2023 Mar;38(1):56-59. 10.7180/kmj.22.134.

Bochdalek hernia presenting gastrointestinal symptoms in late childhood: a case report

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea

Abstract

Most cases of congenital diaphragmatic hernia (CDH) can be diagnosed based on symptoms of severe respiratory failure during the neonatal period or fetal ultrasonography. However, some rare cases are diagnosed in late childhood or adolescence. In this case report, I describe an 11-year-old male patient diagnosed with late-onset CDH presenting with acute abdominal pain. The patient had recently experienced anorexia, nausea, and vomiting after eating. However, he reported no abdominal pain or past history of trauma. The abdomen was generally convex. All laboratory data were within normal limits. A chest X-ray revealed elevation of the left diaphragm. Chest computed tomography showed a defect in the left diaphragm. Based on the above radiologic findings, emergency surgery was performed after the diagnosis of diaphragmatic hernia. A surgical incision was performed in the left subcostal area. Finally, late-presenting Bochdalek hernia was diagnosed. The operation was completed and no specific findings on chest X-ray were found after surgery. The patient was discharged on the fourth day after surgery. In conclusion, CDH in late childhood or adolescence is rare and has various clinical manifestations. To avoid complications such as strangulation and bowel perforation, emergency surgery may be required. Thus, it is necessary to suspect CDH in children with recurrent gastrointestinal or respiratory symptoms, based on which an accurate diagnosis can be made and successful surgical treatment can be performed.

Keyword

Abdominal pain; Bochdalek hernia; Case reports; Congenital diaphragmatic hernias

Figure

  • Fig. 1. Initial chest X-ray showing elevation of the left hemidiaphragm and volume reduction of the left lung.

  • Fig. 2. A chest computed tomography (CT) image revealing a diaphragmatic defect in the left side. (A) Preoperative axial thoracic CT image. (B) Preoperative coronal thoracic CT image.

  • Fig. 3. Postoperative chest X-ray after congenital diaphragmatic hernia repair shows a clean contour of the diaphragm and normal parenchyma of the lung.


Reference

References

1. Kim DJ, Chung JH. Late-presenting congenital diaphragmatic hernia in children: the experience of single institution in Korea. Yonsei Med J. 2013; 54:1143–8.
2. Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, et al. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg. 2017; 12:23.
3. Close O. More than just a cough: late presentation of congenital diaphragmatic hernia. J Paediatr Child Health. 2020; 56:1302–4.
4. Puri P, Wester T. Historical aspects of congenital diaphragmatic hernia. Pediatr Surg Int. 1997; 12:95–100.
5. Gallot D, Boda C, Ughetto S, Perthus I, Robert-Gnansia E, Francannet C, et al. Prenatal detection and outcome of congenital diaphragmatic hernia: a French registry-based study. Ultrasound Obstet Gynecol. 2007; 29:276–83.
6. Mishalany H, Gordo J. Congenital diaphragmatic hernia in monozygotic twins. J Pediatr Surg. 1986; 21:372–4.
7. Waseem M, Quee F. A wheezing child: breath sounds or bowel sounds? Pediatr Emerg Care. 2008; 24:304–6.
8. Kitano Y, Lally KP, Lally PA; Congenital Diaphragmatic Hernia Study Group. Late-presenting congenital diaphragmatic hernia. J Pediatr Surg. 2005; 40:1839–43.
9. Haines JO, Collins RB. Bochdalek hernia in an adult simulating a pleural effusion. Radiology. 1970; 95:277–8.
10. Hegarty MM, Bryer JV, Angorn IB, Baker LW. Delayed presentation of traumatic diaphragmatic hernia. Ann Surg. 1978; 188:229–33.
11. Kadian YS, Rattan KN, Verma M, Kajal P. Congenital diaphragmatic hernia: misdiagnosis in adolescence. J Indian Assoc Pediatr Surg. 2009; 14:31–3.
12. Berman L, Stringer D, Ein SH, Shandling B. The late-presenting pediatric Bochdalek hernia: a 20-year review. J Pediatr Surg. 1988; 23:735–9.
13. Blackstone MM, Mistry RD. Late-presenting congenital diaphragmatic hernia mimicking bronchiolitis. Pediatr Emerg Care. 2007; 23:653–6.
14. Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of incidental Bochdalek's hernia in a large adult population. AJR Am J Roentgenol. 2001; 177:363–6.
15. Obata S, Souzaki R, Fukuta A, Esumi G, Nagata K, Matsuura T, et al. Which is the better approach for late-presenting congenital diaphragmatic hernia: laparoscopic or thoracoscopic? A single institution's experience of more than 10 years. J Laparoendosc Adv Surg Tech A. 2020; 30:1029–35.
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