What is the presentation of Bochdalek hernia in an adult?

From the Guidelines

Bochdalek hernia in adults typically presents with nonspecific respiratory and gastrointestinal symptoms.

Presentation of Bochdalek Hernia

The symptoms of Bochdalek hernia (BH) in adults can be very insidious and may include:

• Gastrointestinal symptoms such as intestinal obstruction, gastric obstruction, strangulation, volvulus, incarceration, dysphagia, and bleeding
• Respiratory symptoms such as dyspnea These symptoms can be complicated by the herniation of abdominal organs into the thoracic cavity, leading to secondary visceral complications 1.

Diagnosis and Clinical Presentation

The diagnosis of Bochdalek hernia can be difficult due to its rarity and wide range of presenting symptoms, with an incidence of 0.17% presenting at an average age of 40 years 1. The clinical presentation of Bochdalek hernia can be divided into three phases: the acute phase, the latent phase, and the obstructive phase, with nonspecific GI and respiratory symptoms caused by the herniation of intra-abdominal viscera into the thoracic cavity 1. In some cases, the diagnosis of Bochdalek hernia may be delayed, leading to misdiagnosis and inappropriate management, with delayed presentation being common and asymptomatic for decades before becoming symptomatic in later stages 1. It is essential to consider Bochdalek hernia in the differential diagnosis of adults presenting with nonspecific respiratory and gastrointestinal symptoms to ensure prompt and appropriate management 1.

From the Research

Presentation of Bochdalek Hernia in Adults

The presentation of Bochdalek hernia in adults can vary, but common symptoms include:

• Abdominal pain 2, 3, 4
• Vomiting 2
• Dyspnea 3
• Dysphagia 4
• Constipation 4
• Shortness of breath 4
• Choking 4

Diagnosis and Treatment

Diagnosis of Bochdalek hernia in adults can be challenging, but imaging tests such as CT scans are essential for accurate diagnosis 2, 5. Treatment typically involves surgical repair of the hernia, which can be performed laparoscopically 6, 4. The goal of surgery is to reduce the herniating organ and repair the defect 5.

Complications

Bochdalek hernia in adults can be associated with complications such as:

• Gastric volvulus, where the stomach twists on itself, leading to potentially serious symptoms such as severe abdominal pain and vomiting 2
• Intestinal obstruction and strangulation, which can be life-threatening if not treated promptly 5
• Visceral strangulation, which can occur if the hernia is not treated surgically 6

Rare Cases

There have been reports of rare cases of Bochdalek hernia in adults, including:

• Right-sided Bochdalek hernia, which is much less common than left-sided hernias 3, 6
• Strangulated Bochdalek hernia, which requires timely recognition and surgical intervention to prevent a lethal outcome 5