Abstrakt: |
INTRODUCTION/OBJECTIVES: Bochdalek hernia represents a rare condition accounting for 0,17-6% of all diaphragmatic hernias due to failure of pleuroperitoneal membrane closure in utero causing incompetence of posterolateral foramina to fuse properly. Clinical manifestations often arise in children, especially on the left side. Infrequently, it can go undiagnosed until its symptomatic presentation in adulthood or even being asymptomatic incidental multi-sliced computed tomography (MSCT) finding. CASE PRESENTATION: A 27-year-old female patient has been referred for occasional pain in the left shoulder, left hypochondrium, and umbilicus that was initially described in 2014 during college admission but recently has become more frequent with higher intensity. The pain was accompanied by occasional right mandibular stiffness and could have been resolved with non-steroidal anti-inflammatory drugs. Hematochezia and post-defecation pain were also reported and attributed to a doubtful anal fissure. In previous years, she underwent an extensive, but inconclusive medical evaluation including orthopedic, psychiatric, allergological, and partial GI. During the actual GI assessment, a colonoscopy was attempted but could not be completed because of the severe abdominal and shoulder pain. Subsequent CT colonography revealed elongated descending and part of the transverse colon with spleen and left kidney situated almost adjacent to the left pulmonary apex. Finally, she underwent a surgical procedure consisting of a left posterolateral thoracotomy with diaphragmatic hernioplasty. CONCLUSION: Even though Bochdalek hernia is a rare entity, it should be kept in mind when we evaluate patients with nonspecific symptoms of longer duration. Despite an incomplete colonoscopy, evaluation of pain and GI hemorrhage should be finalized by radiological examination. [ABSTRACT FROM AUTHOR] |