Operative management of traumatic rupture of diaphragma in elderly with Bochdalek hernia: a rare case report

Abstract

Diaphragmatic hernia is a displacement of the abdominal viscera organs into the thoracic cavity due to a defect in the diaphragm. The most common type is failure fusion of the Bochdalek’s foramen. We report the case of a 76-year-old woman with discomfort in the right chest area since 1.5 months ago. Shortness of breath and nausea accompanied the complaints. The patient admitted that eight months before hospital admission, she was hit by a motorbike, fell towards the back, and hit her back. After the incident, the patient reported one episode of hematemesis and melena. On physical examination, the conjunctiva was pale. The anterior and posterior thoracic regions appeared asymmetrical, the fremitus was asymmetrical, and there was increased diaphragmatic excursion with bowel sounds on the right thorax. An image that leads to a right Bochdalek hernia was obtained on thoracic multi slice computed tomography (MSCT) with contrast. The patient underwent thoracotomy and diaphragm repair using mesh. The thoracic approach aims to reduce visceral-pleural adhesions and visceral intrathoracic perforation. Right-sided Bochdalek hernia in the elderly is rare, but trauma is very likely to occur and worsen the patient's condition. Late diagnosis and inadequate management are associated with incarceration and strangulation with high mortality rates. In this case, thoracotomy approach proved to be a useful method for hernias due to chronic defects in the diaphragm.