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


  • Hotiatun Department of Surgery, Medical Faculty of Sebelas Maret University/Dr. Moewardi Hospital, Surakarta, Indonesia
  • Lauraine W. Sinuraya Department of Surgery, Medical Faculty of Sebelas Maret University/Dr. Moewardi Hospital, Surakarta, Indonesia
  • Prima K. Hayuningrat Department of Surgery, Medical Faculty of Sebelas Maret University/Dr. Moewardi Hospital, Surakarta, Indonesia
  • Soebandrijo Department of Surgery, Medical Faculty of Sebelas Maret University/Dr. Moewardi Hospital, Surakarta, Indonesia




Case report, Bochdalek hernia, Thoracic trauma, Thoracotomy


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.


Spiridakis KG, Flamourakis ME, Gkionis IG, Kaloeidi EI, Fachouridi AI, Konstantoulaki SE, et al. Right-sided strangulating diaphragmatic hernia in an adult without history of trauma: a case report. J Med Case Rep. 2021;15(1):1-4.

Spellar K, Gupta N. Diaphragmatic Hernia. StatPearls. 2022.

Furák J, Athanassiadi K. Diaphragm and transdiaphragmatic injuries. J Thorac Dis. 2019;11(3):S152-7.

Ohtsuka Y, Suzuki TH. Right-sided Bochdalek hernia in an elderly patient: a case review of adult Bochdalek hernias from 1982 to 2015 in Japan. Acute Med Surg. 2017;4(2):209-12.

Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, et al. Emergency surgery due to diaphragmatic hernia: Case series and review. World J Emerg Surg. 2017;12(1):1-18.

Boumarah D, Alsinan A, Alothman O, AlDandan O, Alshomimi S. Acquired right-sided diaphragmatic hernia in a patient with retroperitoneal hydatidosis: a case report and review of the literature. J Med Case Rep. 2021;15(1):1-7.

Mittal A, Cay P, Singh K. Laparoscopic management of acute presentations of obstructed, congenital, diaphragmatic hernias in adults: case reports. Ann Laparosc Endosc Surg. 2020;5(10)1-7.

Miyasaka T, Matsutani T, Nomura T, Hagiwara N, Chihara N, Takahashi K, et al. Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan. Surg Case Reports. 2020;6(1):233.

Zhao L, Han Z, Liu H, Zhang Z, Li S. Delayed traumatic diaphragmatic rupture: Diagnosis and surgical treatment. J Thorac Dis. 2019;11(7):2774-7.

Moro K, Kawahara M, Muneoka Y, Sato Y, Kitami C, Makino S, et al. Right-sided Bochdalek hernia in an elderly adult: a case report with a review of surgical management. Surg Case Reports. 2017;3(1):109.

Kesavaramanujam S, Morell MC, Harigovind D, Bhimmanapalli C, Cassaro S. Total thoracic herniation of the liver: a case of delayed right-sided diaphragmatic hernia after blunt trauma. Surg Case Reports. 2020;6(1):4-9.

Bordoni B, Morabito B, Simonelli M. Ageing of the Diaphragm Muscle. Cureus. 2020;12(1):e6645.

Kishore A, Singh A, Jain A. Traumatic Diaphragmatic Hernia: A Case Report. Int Surg J. 2018;5(6):2378-82.

Koerniawan HS, Atmadjaya NK, Wiargitha K. Late Diagnosis of Traumatic Diaphragmatic Rupture : Experience in Developing Country. 2020;47(10):763-5.

Agalar C, Atila K, Arslan NC, Derici ZS, Bora S. Adult morgagni hernia: A single-center experience of five cases and a review of literature. Turkish J Surg. 2018;8.

Osman NM. Acquired traumatic diaphragmatic hernia with delayed presentation in a child. Sudan J Med Sci. 2019;14(1):9-14.

Akita M, Yamasaki N, Miyake T, Mimura K, Maeda E, Nishimura T, et al. Bochdalek hernia in an adult: two case reports and a review of perioperative cardiopulmonary complications. Surg Case Reports. 2020;6:1.

Silva GP, Cataneo DC, Cataneo AJM. Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis. Acta Cir Bras. 2018;33(1):49-66.

Filosso PL, Guerrera F, Sandri A, Lausi PO, Lyberis P, Bora G, et al. Surgical management of chronic diaphragmatic hernias. J Thorac Dis. 2019;11(1):S177-85.

Le ST, Nguyen HT, Ho TC, Tiep NV. Traumatic Diaphragmatic Rupture in An Elderly Patient With Polytrauma. Res Sq. 2021;6:1-6.






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