A case of adult right-sided bochdalek hernia with strangulation ileus

Abstract

An 85-year-old man was referred to our hospital because of constipation and abdominal pain. On admission, he showed no abdominal tenderness, but blood tests showed a mild inflammatory reaction, elevated escape enzyme levels, and metabolic acidosis. An abdominal contrast computed tomography (CT) scan showed herniation of the small intestine into the right thoracic cavity from the posterior surface of the right hepatic lobe, which was atrophic. The finding of a reduced contrast effect and thickening of the wall of the herniated small intestine led to the diagnosis of incarcerated hernia of the right diaphragm with strangulation ileus. The patient, therefore, underwent emergent surgery. Surgical findings confirmed the presence of an oval hernial orifice with a diameter of 3 cm in the right posterior surface of the diaphragm. Because the ileum was incarcerated in the hernia orifice, the diagnosis of right-sided Bochdalek hernia was made. The ileum was necrotic over an area of 45 cm in length and was surrounded by a bloody pleural effusion. Therefore, partial resection of the necrotic ileum was performed, followed by right thoracic drainage, and the hernial orifice was closed by suture. Remission was achieved, and the patient was discharged on the 12^th day after surgery. Right-sided Bochdalek hernia is rare in adults. Here, we report our experience with a single case of right-sided Bochdalek hernia, which occurred in an elderly patient secondary to strangulation ileus.