Caecal perforation with faecal peritonitis - unusual presentation of Bochdalek hernia in an adult: a case report and review of literature

Abstract

The improper fusion of the postero-lateral foramen of the diaphragm was first described by Bochdalek in 1848. The incidence of congenital diaphragmatic hernia varies from1:2000 to 1:5000 live births and Bochdalek hernias (BH) account for 75 to 85% of these. Although it is a well-known entity in neonates, it is occasionally discovered incidentally in adult patients. Until now, a total of around 100 cases of occult asymptomatic Bochdalek hernia have been reported. The symptomatic cases are encountered more rarely. Colon necrosis among the symptomatic cases was reported in some reports. We discuss the present case since we believe it to be, to the best of our knowledge, the first case of a Bochdalek hernia in an adult presenting with caecal perforation and faecal peritonitis and review the published literature about this rare condition.

Figure 1

Chest X-ray showing free air under diaphragm (single arrow head) along with the Bochdalek hernia on the right side (double arrow head).

Figure 2

Intraoperative picture showing markedly dilated caecum with perforation temporarily controlled by silk sutures.

Figure 3

Intraoperative picture showing transverse colon entering the posterolateral defect in the left diaphragm, B: Bochdalek hernia, S: Spleen, C: Transverse Colon.

Figure 4

Intraoperative picture of the defect having been enlarged to reduce the hernia.