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CASE REPORT
Massive symptomatic right-sided Bochdalek hernia in an adult man
  1. Naman Kohli,
  2. Goran Mitreski,
  3. Cheng-Hon Yap,
  4. Matthew Leong
  1. Department of Surgery, Barwon Health, Geelong, Victoria, Australia
  1. Correspondence to Dr N Kohli, namankohli{at}y7mail.com

Summary

A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.

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Footnotes

  • Contributors NK: conception and design, acquisition of the data or analysis and interpretation of data. Drafting the article for important intellectual content. Final approval of the version published. GM, C-HY and ML: revising case report critically for important intellectual content. Final approval of the version published. All authors agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.