J Cardiothorac Surg
. 2026 Apr 24.
doi: 10.1186/s13019-026-04202-w. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/42032629/
Late-presenting left Bochdalek hernia with intrathoracic transverse colon causing progressive exertional dyspnea: a case report
Mohammad Alaa Aldakak 1, Ahmad Bishr Nasra 2, Yamama Abo Dakka 2, Bassel Ibrahim 2, Hussain Chaban 2
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- PMID: 42032629
- DOI: 10.1186/s13019-026-04202-w
Free article
Abstract
Background: Bochdalek hernia is a congenital posterolateral diaphragmatic defect that typically presents in infancy, yet some defects remain clinically silent and are first detected in adulthood. Adult cases may be incidental or present with nonspecific respiratory or gastrointestinal symptoms, and cross-sectional imaging is often required for definitive diagnosis.
Case presentation: A 65-year-old woman presented with two months of fatigue and progressive exertional dyspnea without gastrointestinal complaints. Examination demonstrated decreased breath sounds and crackles at the left lung base. Chest radiography showed a left lower thoracic air-fluid level with abnormal contour of the left hemidiaphragm. Contrast-enhanced CT confirmed a large left posterolateral diaphragmatic hernia with a hernia sac measuring 15 × 7 cm, containing omentum and an air-containing abdominal viscus, associated with left basal compressive atelectasis. Upper endoscopy revealed an incompetent cardia and a 3-cm sliding hiatal hernia, considered incidental in the absence of gastrointestinal symptoms. Postoperatively, lung re-expansion was satisfactory and the chest tube was removed on postoperative day 7 without gastrointestinal symptoms.
Case discussion: Surgery was planned laparoscopically, but intraoperative findings demonstrated a very large incarcerated hernia with difficult and potentially unsafe reduction via the abdominal approach, prompting conversion to a transthoracic strategy. Left posterolateral thoracotomy enabled adhesiolysis, sac dissection, reduction of herniated transverse colon and omentum, sac excision, and layered diaphragmatic repair using nonabsorbable sutures anchored to the ribs, with chest tube placement.
Conclusion: This case highlights that adult Bochdalek hernia may present predominantly with respiratory symptoms and that operative access should be individualized. Transthoracic repair can be advantageous when incarceration and intrathoracic adhesions limit safe transabdominal reduction.
Keywords: Adult presentation; Bochdalek hernia; Case report; Congenital diaphragmatic hernia; Thoracotomy.
© 2026. The Author(s).
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