Abstract
Congenital diaphragmatic hernia (CDH) is caused due to abnormal formation of the muscular parts of diaphragm. The incidence of CDH in common births ranges from 1/25000 to 1/30000. Pulmonary hypoplasia and pulmonary hypertension are factors that associate with the increase of mortality and morbidity due to CDH. We presented a 68-year-old Iranian woman with abdominal pain and tenderness in right upper quadrant who was diagnosed as having CDH. The disease was detected using chest X-ray and chest and abdomen sonography and confirmed with chest and abdomen CT scan with and without oral contrast. A defect was revealed in posterolateral right diaphragm with omentum and transverse colon herniated through it. Right posterolateral thoracotomy was performed to cure the disease. CT and CXR were the two useful methods in diagnosis of CDH in this patient, although CDH detection prior to surgery is too challenging because of rare cases and different types of CDH. In order to improve clinical cares in adult CDH patients, investigating more cases and long term follow-up are recommended.
Highlights
Congenital diaphragmatic hernia (CDH) occurs due to incomplete muscularization of the diaphragm
We have reported an elderly patient with right congenital diaphragmatic hernia diagnosis and delayed gastrointestinal clinical manifestation
Due to the complexity of congenital diaphragmatic hernia the factors involved in the development of Bochdalek hernia are unknown; at present its cause is expressed to be the lack of closure of pleural and peritoneal cavity due to disruption of molecular signaling during organogenesis during the 9th to 10th weeks of pregnancy [9,10,11]
Summary
Congenital diaphragmatic hernia (CDH) occurs due to incomplete muscularization of the diaphragm. The diaphragm is rarely engaged in both sides [1, 2] The survival of these patients is estimated to be 55–65% [3]. Despite the high prevalence of Bochdalek hernia during infancy, the disease is rare in adults and the diagnosis of this type of hernia is very difficult and, in most patients, it is not diagnosed due to the mild delayed manifestation of CDH. The most common clinical manifestation in infants is respiratory distress while, in adults, mild respiratory and gastrointestinal symptoms are more prevalent, and 25% of the hernia is asymptomatic [6]. We have reported an elderly patient with right congenital diaphragmatic hernia diagnosis and delayed gastrointestinal clinical manifestation
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