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

Ameet Kumar,Samaresh Sahu,Vikas Maheshwari,T S Ramakrishnan

doi:10.1186/1749-7922-4-16

Ameet Kumar, Samaresh Sahu + Show 2 more

Open Access

https://doi.org/10.1186/1749-7922-4-16

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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.

Highlights

A diaphragmatic hernia may be congenital or secondary to a traumatic rupture of the diaphragm
A medline search has revealed only a few cases of colonic necrosis in symptomatic cases wherein primary colo-colonic anastomosis was employed [3]. Another case presenting with perforation of the transverse colon was managed with Video assisted thoracoscopic surgery (VATS) and laparotomy [5]
We report the present case since we believe it to be the first adult Bochdalek hernia presenting with perforation of the caecum and faecal peritonitis secondary to a closed loop obstruction and review the published literature

Summary

Introduction

A diaphragmatic hernia may be congenital or secondary to a traumatic rupture of the diaphragm. Over 100 cases of occult Bochdalek hernias in asymptomatic adults have been reported in the literature [2,3]. A medline search has revealed only a few cases of colonic necrosis in symptomatic cases wherein primary colo-colonic anastomosis was employed [3]. Another case presenting with perforation of the transverse colon was managed with Video assisted thoracoscopic surgery (VATS) and laparotomy [5]. We report the present case since we believe it to be the first adult Bochdalek hernia presenting with perforation of the caecum and faecal peritonitis secondary to a closed loop obstruction and review the published literature

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Discussion

Conclusion