Adult left-sided Bochdalek hernia with multivisceral herniation: A case report and systematic review of literature

Abstract

Bochdalek hernia is a congenital posterolateral diaphragmatic defect that typically presents during the neonatal period with severe respiratory compromise. Adult presentation is rare and often manifests with vague respiratory or gastrointestinal symptoms, making diagnosis challenging and frequently delayed. A 65-year-old female presented with progressively worsening shortness of breath and severe orthopnea for 20 days. She also reported a longstanding history of mild exertional dyspnea over 4–5 years. There was no history of thoracoabdominal trauma or prior surgery. Chest radiography demonstrated abnormal soft tissue shadows within the left hemithorax. Contrast-enhanced computed tomography of the thorax and abdomen confirmed a 5 cm × 5 cm left posterolateral diaphragmatic defect with multivisceral herniation including the stomach, spleen with splenic artery, omentum, transverse colon, and upper pole of the left kidney, consistent with an adult left-sided Bochdalek hernia. The patient underwent exploratory laparotomy through an L-shaped incision. The herniated abdominal viscera were carefully reduced into the abdominal cavity, and the diaphragmatic defect was repaired primarily using nonabsorbable sutures. The postoperative course was uneventful. The patient experienced immediate improvement in respiratory symptoms with complete resolution of orthopnea and was discharged in stable condition without complications. Adult Bochdalek hernia should be considered in elderly patients presenting with unexplained respiratory symptoms, even in the absence of a history of trauma. Cross-sectional imaging plays a crucial role in diagnosis and operative planning. Early surgical repair is essential to prevent life-threatening complications such as strangulation and visceral ischemia.