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

• Jeong SS

• KMID: 2540763
• DOI: http://doi.org/10.7180/kmj.22.134

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

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

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  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.

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  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

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