Chronic Left-sided Bochdalek Diaphragmatic Hernia in an Adult with Delayed Presentation: A Case Report of Surgical Management via Midline Laparotomy

Chronic Bochdalek diaphragmatic hernia in adult patients is a clinically rare condition that may have gastrointestinal or respiratory-related symptoms (inclusive of cough, progressive dyspnea, and postprandial abdominal pain) and thus be incorrectly diagnosed and managed. The present case is of a 60-year-old Indian male who presented with a history of 8 days of progressive dyspnea, cough, and postprandial abdominal pain. Imaging with high-resolution computed tomography (CT) and contrast-enhanced CT revealed a large chronic left posterolateral diaphragmatic defect with herniation of the stomach and small bowel loops leading to a mediastinal shift and compression of the left lung. The initial imaging was performed at an outside hospital, following which the patient was referred to our center for definitive surgical management. The patient underwent successful anatomical repair through a midline laparotomy, including reduction of the herniated viscera and primary closure of the diaphragmatic defect. Postoperatively, he developed bronchopulmonary fistula and persistent air leak which needed a prolonged intercostal drainage and supportive care followed by gradual improvement. This case highlights the difficulties in the diagnosis of adult Bochdalek hernias and the role of high clinical suspicion, prompt imaging, and multidisciplinary perioperative care in avoiding complications and achieving positive outcomes.