Intestinal obstruction and colonic ischemia secondary to Bochdalek diaphragmatic hernia in an adult from Porlamar, Venezuela

Abstract

Introduction: Bochdalek congenital diaphragmatic hernia (CDH) is an infrequent pathology in adults, typically presenting as a surgical emergency due to obstructive or ischemic complications of herniated abdominal organs. Objective: To report the clinical experience in the management of a complicated adult Bochdalek hernia. Case report: A 29-year-old male presented with a four-day history of obstipation, colicky abdominal pain, nausea, and dyspnea. Physical examination revealed abdominal distention, involuntary muscle guarding in the left upper quadrant, and absent breath sounds at the left lung base. Radiography showed colonic loop dilation up to the splenic flexure and elevation of the left hemidiaphragm. Based on the clinical suspicion of intestinal obstruction due to a diaphragmatic hernia, an emergency laparotomy was performed. A 10-cm diaphragmatic defect was identified, containing the stomach, splenic flexure, and omentum; the latter showed massive necrosis. Segmental colectomy, Hartmann-type colostomy, and primary diaphragmatic repair were performed. The patient had an uneventful recovery and was discharged after 12 days. Conclusion: High clinical suspicion and timely surgical intervention are crucial to reducing morbidity and mortality in complicated adult diaphragmatic hernias.