Bochdalek Hernia in an Adult Presenting as Hydropneumothorax due to Gastric Volvulus Perforation: A Case Report

Congenital Diaphragmatic Hernia (CDH) occurs due to herniation of abdominal contents into the thorax through a defect in the diaphragm caused by incompletely fused pleuro-peritoneal folds. It is classified into three types, of which Bochdalek hernia is the most common type. Here the authors report a case of a 24-year-old male patient, who presented with sudden onset of abdominal and chest pain with multiple episodes of non bilious vomiting since two days. Computerised Tomography (CT) suggested the possibility of a Bochdalek hernia with mesentroaxial gastric volvulus and intrathoracic gastric perforation causing hydropneumothorax, which was confirmed on surgery. The gastric perforation was closed and the herniated abdominal contents were reduced and the diaphragmatic rent was repaired. His postoperative recovery was unremarkable. Bochdalek hernias may infrequently remain asymptomatic till adulthood, where they may manifest suddenly with serious chest or abdominal complaints. Computerised tomography is a rapid imaging tool that can provide a precise preoperative diagnosis and a road map for the operating surgeon.