Complications de la hernie de Bochdalek méconnue de l’adulte. Revue de la littérature

Abstract

Aim of the study: To report 3 new cases of complicated Bochdalek hernia (BH) in adulthood and to review the literature about this rare condition. Case report: Three adult patients were operated on for a BH undiagnosed until occurrence of acute complication. The first patient, 27 years-old, had small bowel obstruction and the diagnosis of BH, unrecognized on chest X-ray, was established on barium meal and CT scan. The second patient, 38 years-old, had epigastric pain and gastric obstruction: diagnosis of BH, unrecognized at a previous laparotomy, was established on CT scan and barium enema. The third patient, 88 years-old, had respiratory failure and gastric obstruction: diagnosis of BH, unrecognized on chest X-ray, was established on CT scan. The 3 patients were operated on through laparotomy ( n=2) ou thoracotomy ( n=1) with one post-operative death. Discussion: In adulthood, BH can remain asymptomatic for a long time before occurrence of a acute digestive or respiratory complication. Chest X-ray can be normal or misinterpreted. CT scan seems to be the most reliable examination to diagnose BH. Conclusion: In adulthood, diagnosis of BH should be evocated in case of respiratory or upper digestive symptoms.