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A spontaneous adult right-sided Bochdalek hernia containing perforated colon

JRSM Short Reports
SAGE Publications
Publication Date
DOI: 10.1258/shorts.2011.011056
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  • Case Report
  • Education
  • Medicine


SHORTS-11-056 1..5 A spontaneous adult right-sided Bochdalek hernia containing perforated colon Alistair AP Slesser1 • Hannah Ribbans2 • Dominic Blunt3 • Rex Stanbridge4 • Gordon N Buchanan5 1Department of General Surgery, Watford General Hospital, Watford, UK 2Imperial College London, UK 3Department of Radiology, Charing Cross Hospital, London, UK 4Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK 5Department of Colorectal Surgery, Charing Cross Hospital, London, UK Correspondence to: Alistair AP Slesser. Email: [email protected] Bochdalek hernias containing perforated colon are rare and require colorectal and thoracic surgical expertise to ensure a good outcome. Case report A 37-year-old woman was admitted to a district general hospital with a five-day history of short- ness of breath, vomiting and right upper quadrant and right shoulder tip pain. She was passing flatus but had not opened her bowels for five days with no relevant previous history, except a previous uneventful pregnancy by vaginal deliv- ery three years previously. On examination she was tachycardic (110 bpm), normotensive and had saturations of 95% on 4 L of oxygen. Abdomi- nal examination was unremarkable. Laboratory tests revealed: Hb 12.0 g/dl, WCC 18600/mm3, CRP 453 mg/L, Bilirubin 46 μmol/L. An arterial blood gas demonstrated: pH 7.452, p02 10.4, Lactate 1.0 and B.E –3.7. No clear clinical diagno- sis was made. Computed tomography (CT) performed two days later showed herniation of the right colon through a posterior defect in the right hemi-diaphragm with free gas in the thorax and abdomen suggesting perforation (Figures 1 and 2). The patient was transferred the same evening to our teaching hospital surgical unit for specialist care with a temperature of 37.5˚C, tachycardia 125 bpm, respiratory rate of 30/min and satur- ations of 98% on 35% of oxygen. Respiratory examination revealed absent breath sounds in her right chest. Immediate combine

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