Strangulated Bochdalek Hernia: Approach of Management in Emergency Setting

Bochdalek hernia is a type of congenital diaphragmatic hernia that primarily manifests in children however in rare instances they do manifest in adulthood spontaneously or after physical exertion. We report a case of a left-sided Bochdalek hernia in an adult who presented with left-sided chest pain and worsening symptoms of dyspnea. His chest radiograph revealed dilated small bowel loops in the left hemithorax causing a mediastinal shift. A computed tomography done revealed a posterolateral diaphragmatic defect through which the abdominal viscera had herniated. He was subsequently intubated due to severe respiratory distress. The patient underwent an emergency laparotomy which revealed a large 10 cm posterolateral diaphragmatic defect with herniation of small bowel, spleen and transverse colon. The small bowel was gangrenous and perforated therefore a primary repair of the defect with non-absorbable sutures was done. Gangrenous bowel was resected and primary anastomosis was done. Postoperatively, the patient had significant clinical improvement and was discharged a week later with no immediate complications.