Abstract
This paper presents a case of Bochdalek's hernia causing gastric perforation in the thoracic cavity with mediastinal displacement in an adult who follwed a serious clinical course.
A 22-year-old woman was admitted to our hospital because of left upper abdominal pain and vomiting. A chest rentgenogram on admission showed niveau in the left pleural cavity. She had an abrupt onset of severe chest pain and dyspnea six hours after admission. A chest rentgenogram showed displacement of the mediastinum. She was diagnosed as having posterolateral diaphragmatic hernia with gastric perforation. Emergency operation was performed via abdominal approach. There was a defect in the posterolateral part of left diaphragm (Foramen Bochdalek). The stomach and spleen were displaced into the left thoracic cavity. Partial resection of the stomach that included the site of perforation was performed. The diaphragmatic defect was closed with interrupted sutures.
The adult patients with Bochdalek's hernia generally have favorable prognosis, however, those who experience perforation or necrosis of the herniated intestine can have unfavorable prognosis. For such patients we should perform surgery as early as possible after making the diagnosis.
