2710 Asymptomatic Bochdalek Hernia in an Adult Male: A Rare Entity

Abstract

INTRODUCTION: Bochdalek hernias (BH) are a type of congenital diaphragmatic hernia that mostly present in children. The diagnosis of a Bochdalek hernia in an adult patient is extremely rare accounting for an estimated 0.17% to 6% of all diaphragmatic hernias. Here we present a case of an asymptomatic Bochdalek hernia in adult patient. CASE DESCRIPTION/METHODS: Patient is a 51 year old female with a medical history of mental retardation, diabetes mellitus type 2, who was referred to our gastroenterology clinic for chronic constipation and abdominal mass. Per the patients nursing aid, on prior exam an abdominal mass was palpated on routine physical exam. On presentation to our clinic her physical exam was unremarkable. Recent complete blood count and comprehensive metabolic panel were within normal limits. Given these findings a computed tomography scan of the abdomen was done. This was done and showed no masses within the gastrointestinal tract, but was remarkable for a moderate sized left bochdalek type hernia with associated herniation of the third and fourth portions of the duodenum and the splenic flexure of the colon, without CT evidence of incarceration. On return visit, the patients nursing aid and family were notified of the findings, but refused surgical intervention for possible correction. She remained asymptomatic on follow up visits and the family continued to refuse treatment. DISCUSSION: Bochdalek hernias (BH) result are a rare congenital anomaly that results from a persistent pleuroperitoneal that occurs due to failure of the postero-lateral foramina to fuse. This allows contents of the abdomen to herniate into the thorax. Symptoms of BH depend on location. Right sided BHs may present with herniation of the liver and intestine. Left sided BHs may present with herniation of the stomach, small intestine and colon. Diagnosis of BH in adults can be challenging as symptoms are non-specific (mild abdominal pain) and up to 25% of patients are asymptomatic. Diagnosis of BHs in adults can be accomplished through imaging modalities such as computed tomography, magnetic resonance imaging, and fluoroscopy. The treatment of choice for BH is surgical repair. This should be considered in asymptomatic patients as well, given the potential for strangulation of the herniated contents.