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Abstract Background Bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. In contrast, diagnosis of a Bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm. Even more rare is the diagnosis of a right-sided Bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases.
Case presentation We describe a case of an year-old female who presented with abdominal pain. An abdominal computed tomography CT scan showed decreased intravenous contrast uptake and thickening of the wall of herniated small intestine through the right side of the diaphragm, which led to the diagnosis of a strangulated diaphragmatic hernia. The patient underwent emergent laparotomy and required a partial resection of the necrotic ileum and a hernia repair with direct closure.
Interestingly, in this case, organ malformation was not observed. Conclusions Adult right-sided Bochdalek hernia with strangulation in the absence of hepatic atrophy is a rare entity. Considering the severity of this condition, accurate diagnosis and proper treatment are needed.
A tailored operative approach is required on an individual case basis. Keywords: Bochdalek hernia, Strangulation, Adult, Right-sided Go to: Background Bochdalek hernia is a diaphragmatic hernia usually diagnosed during the neonatal period. It typically occurs in the left hemi-diaphragm and presents with severe respiratory and circulatory compromise. Thus, the mortality rate is high. Adult Bochdalek hernia is rare, and most are also found on the left side of the diaphragm because the right pleuroperitoneal canal closes earlier and the liver buttresses the right diaphragm, minimizing the opportunity for herniation into the right thoracic cavity [ 1 — 3 ].
However, as a corollary to this rationale, organ malformation consisting primarily of hepatic atrophy can increase the risk of a right-sided diaphragmatic hernia. Few of these rare cases have been reported. An adult Bochdalek hernia is usually precipitated by a state of increased intra-abdominal pressure, such as that induced by pregnancy or from prolonged operations under pneumoperitoneum [ 4 ].