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Background Congenital diaphragmatic hernia (CDH) is a severe birth defect associated with high perinatal mortality and long-term morbidity. The etiology of CDH is poorly understood although abnormal retinoid signaling has been proposed to contribute to abnormal diaphragm development. Existing epidemiological data suggest that inadequate dietary vitamin A intake is a risk factor for developing CDH. Methods Using a mouse model of teratogen-induced CDH, the objective of this study was to test the hypothesis that low maternal vitamin A intake contributes to abnormal diaphragm development. To test this hypothesis, we optimized a model of altered maternal dietary vitamin A intake and a teratogenic model of CDH in mice that recapitulates the hallmark features of posterolateral diaphragmatic hernia in humans. Results Our data uniquely show that low maternal dietary vitamin A intake and marginal vitamin A status increases the incidence of teratogen-induced CDH in mice. Conclusion Low dietary vitamin A intake and marginal vitamin A status lead to an increased incidence of teratogen-induced CDH in mice, highlighting the importance of adequate dietary vitamin A intake and CDH risk. Impact This study describes and validates a mouse model of altered maternal and fetal vitamin A status. This study links existing epidemiological data with a mouse model of teratogen-induced congenital diaphragmatic hernia, highlighting the importance of low maternal vitamin A intake as a risk factor for the development of congenital diaphragmatic hernia. This study supports the Retinoid Hypothesis, which posits that the etiology of congenital diaphragmatic hernia is linked to abnormal retinoid signaling in the developing diaphragm.

ispartof: Current Challenges in Thoracic Surgery status: accepted

Congenital diaphragmatic hernia (CDH) occurs as a result of an embryologic developmental defect during gestation. Occasionally, CDH is incidentally discovered in adulthood during radiological testing for other reasons, such as mild dyspnoea or digestive symptoms. Herein, we report a case of posterolateral diaphragmatic hernia presented in adulthood, some years after laparoscopic bariatric surgery.

Abdominal pains in children pose diagnostic difficulties due to their diverse aetiology. The article describes a 7-year-old boy in whom a cause of acute abdominal pain turned out to be posterolateral diaphragmatic hernia which manifested itself atypically late, imitating additionally acute pancreatitis. The diagnostics process was applied, which, after excluding more characteristic causes for this age, led to the correct diagnosis. This case indicates the possibility of disclosure of diaphragmatic hernia in older children, and thus the necessity of widening diagnostics procedures in case of atypical complex of symptoms and the immense significance of modern imaging examinations in determining the correct diagnosis.

Chest wall deformities can be divided into 2 main categories, congenital and acquired. Congenital chest wall deformities may present any time between birth and early adolescence. Acquired chest wall deformities typically follow prior chest surgery or a posterolateral diaphragmatic hernia repair (Bochdalek). The most common chest wall deformities are congenital pectus excavatum (88%) and pectus carinatum (5%). This article addresses the etiology, pathophysiology, clinical evaluation, diagnosis, and management of these deformities.

Congenital Diaphragmatic Hernia (CDH) is defined as the herniation of abdominal contents through an orifice in the diaphragm. Most common type of CDH is the Bochdalek hernia; other types include Morgagni hernia, posterior hernia and Central hernia of the diaphragm. Defect in the diaphragm allows the abdominal organs to push into the proper lung formation leading to hypoplastic lungs and abnormal vessels that cause respiratory insufficiency and persistent pulmonary hypertension with high mortality. The incidence is 1 in 2,500 live-births. This case report is about a full term male baby who died of respiratory distress within a few hours of birth. On dissection, a left-sided posterolateral diaphragmatic hernia with associated intestinal malrotation was found, suggestive of Bochdalek's hernia. Keywords: Dextrocardia, Diaphragmatic hernia, Mediastinal shift, Pulmonary hypoplasia

We present a case of bilateral intrathoracic kidneys and adrenal glands associated with bilateral posterior diaphragmatic defects in a symptomatic 18-month-old baby boy. The diaphragmatic defect did not appear to be the typical posterolateral diaphragmatic hernia of Bochdalek. The patient underwent primary surgical correction through an abdominal approach. Postoperatively, the patient enjoyed an uneventful course and was discharged home without any further events. We discuss this report of bilateral intrathoracic kidneys associated with bilateral diaphragmatic hernias, we describe the operative management, and we analyze the possible embryological development of this defect.

Congenital absence of the left pericardium (allowing communication between pericardial and pleural cavities) is a rare developmental defect that results from faulty partitioning of the pleuropericardic cavity during the 5th week of development. It occurs sporadically in most instances, and may be associated with other malformations of the thoracic viscera. We report here two sibs born to consanguineous parents with absent left fibrous pericardium and developmental defects of the septum transversum: left posterolateral diaphragmatic hernia in one child, left diaphragmatic eventration in the other sib. This appears to be the first familial report of this rare association.

The medical records of 66 surviving children born with congenital posterolateral diaphragmatic hernia (CDH) were reviewed to determine which factors are involved in the development of a recurrent hernia. Fifty-seven patients had a left-sided defect and 9 patients had a right sided defect. In 54 patients the defect was closed primarily and 12 patients required a prosthetic patch. Nine of the 66 patients (14%)--5 patients (9%) with a left-sided defect and 4 patients (44%) with a right-sided defect--developed a recurrent hernia on the average of 4.0 months (range 0.2-6.9) after the initial repair. Except for one, all patients with a recurrence presented with dyspnoea (n = 5) and/or feeding problems (n = 6). Of these 9 recurrences 4 patients (7%) had primary closure of the defect and in 5 patients (42%) a prosthetic patch was required. Four of the 11 patients (36%) who needed extracorporeal membrane oxygenation (ECMO) had a recurrence versus 5 patients (9%) who were conventionally treated. A hernial sac was found in 4 patients during the repair of the recurrent hernia. In 3 of them the initial defect was closed primarily. In conclusion, large-patch repaired defects and right-sided defects are risk factors for the development of a recurrent hernia. Furthermore the lack of a biological union between the sutured patch and the diaphragm tissue remnants is likely to be the cause of a reherniation. Meticulous inspection for a hernial sac during the initial operation could reduce the incidence of a reherniation.

Bochdalek hernia (BH), a closing defect of the peripheral posterior aspect of the diaphragm, is the most common of the congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and varied presentation, these hernias can pose a diagnostic challenge. A right-sided BH in a 40-year-old woman who presented with respiratory distress associated with abdominal pain and symptoms of small-bowel obstruction is reported. Midline laparotomy revealed necrotic small bowel and faecothorax of the pleural cavity. Diaphragmatic hernias should be included in the differential diagnosis of patients with acute or chronic gastrointestinal, or less frequently respiratory, symptoms.

During a period of 5 years, 33 newborns with congenital diaphragmatic hernia were treated. Three groups presenting with respiratory distress in the delivery room were identified. These included 8 newborns with agenesis (group 1) and 4 newborns with nonagenesis (group 2), all of whom died. There were 19 nonagenesis survivors (group 3), giving an overall survival rate of 61%. Two newborns who presented beyond 6 hours of life were excluded. No one specific arterial blood gas value or ventilation parameter obtained preoperatively could predict survival. Postmortem right and left lung weights, lung/body weight ratio, and radial alveolar counts demonstrate that agenesis is a unique subgroup with profound pulmonary hypoplasia and a dismal prognosis.

The clinical and pre- and postoperative radiographic features of 63 babies who presented with congenital (Bochdalek) diaphragmatic hernias were reviewed. Fifty-five babies presented in the neonatal period and eight in later childhood. For neonatal presenters, the preoperative radiographic features were typical in all cases but one (presented with persistent right pleural effusion). Features associated with a poorer prognosis included the presence of a contralateral pneumothorax, absence of contralateral aerated lung and an intrathoracic site for the stomach. Identification of ipsilateral aerated lung was associated with survival in all cases. Typical postoperative features included an ipsilateral pneumothorax, gradual expansion of the lung, gradual elevation of the hemidiaphragm and pleural effusion. Follow-up films demonstrated reduced vascularity in the ipsilateral lung which was commonly smaller than the contralateral lung. The postoperative radiographic features for delayed presenters differed in that lung expansion was usually complete on the first postoperative radiograph and there was no radiographic evidence of pulmonary vascular hypoplasia.

An adult case of right-sided Bochdalek hernia complicating intrathoracic intestinal strangulation is presented. Formation of this rare right-sided diaphragmatic hernia was facilitated by coexistent hypoplasia of the medial segment of left hepatic lobe. Computed tomography showed characteristic findings such as dilated small intestine with convergence of mesenteric folds in the thorax, which was highly diagnostic of intestinal strangulation due to diaphragmatic hernia.

We herein present 2 cases of adult Bochdalek hernia. Only a total of 51 such cases have been reported since 1958, and we have reviewed these cases and discussed their clinical features, operative treatment and final outcome. The majority of these patients presented as acute surgical emergencies and a lack of awareness of this condition lead to an incorrect diagnosis in 38 per cent. Intestinal obstruction with left lung signs and a non-distended abdomen in an adult patient should arouse suspicion of this condition. A plain X-ray of the chest and contrast studies of the gastrointestinal tract are necessary to confirm the diagnosis. A previous normal chest X-ray does not rule out a diaphragmatic hernia, as the defect may be plugged by the spleen or by the presence of a confining sac. The high incidence of strangulation emphasises the need for early diagnosis and prompt operative management which gives highly satisfactory results.

Congenital diaphragmatic hernia through the foramen of Bochdalek may present after infancy. A 21/2-year-old Malay girl presented with acute respiratory distress. Chest examination showed reduced chest expansion and decreased breath sounds on the left side. Chest radiograph showed a large "cyst" in the left chest, which was thought to be a lung cyst under tension. Tube thoracostomy resulted in clinical improvement. Results of a barium study showed that the cyst perforated by the thoracostomy tube was the stomach, which had herniated through a Bochdalek diaphragmatic defect. Surgical repair of the diaphragmatic defect and closure of the perforated stomach was performed successfully. Congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in young children. Nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected.

The effects of maternal exposure to 2, 4-dichlorophenyl-p-nitrophenyl ether (nitrofen) on prenatal lung growth were examined by dietary administration (2,000 ppm in ICR mice and 500 ppm in CD rats). Embryos and/or fetuses (conceptuses) were removed from dams on days 12 to 18 of gestation in mice and on days 14 to 20 of gestation in rats. Body and lung weights of the conceptuses were measured. General growth retardation was noted especially in the later period of intrauterine life in both mice and rats. Bilateral retardation of lung development of the nitrofen exposed conceptuses was noticed throughout intrauterine life including the periods before the closure of pleuroperitoneal canals in both species indicating that nitrofen induced primary lung hypoplasia. In mice, the left lung was more hypoplastic than the right one, while it was opposite in rats. The species specificity in side prevalence of the developmental retardation of the lung was observed even before completion of the embryonic diaphragm and it was well in accord with the side on which posterolateral diaphragmatic hernia (Bochdalek's diaphragmatic hernia, BDH) took place later. We conclude that nitrofen induces primary lung hypoplasia regardless of the presence or absence of BDH.

Congenital diaphragmatic hernia is a relatively rare disorder (1:3000 newborns) that frequently presents with respiratory distress in the immediate neonatal period due to severe pulmonary hypertension and lung hypoplasia. Extracorporeal membrane oxygenation (ECMO) can be used as a last resort when artificial ventilation and/or modulation of the pulmonary vascular tone fail to improve the clinical condition. Situs inversus totalis is a rare condition in which orientation of all asymmetrical organs in the body is a mirror image of the normal morphology.1 Diaphragmatic hernia may be caused by predisposing genes that are involved in left-right axis determination. A few cases of an eventration of the diaphragm combined with situs inversus totalis have been described in the literature. We report for the first time a patient with a right-sided posterolateral diaphragmatic hernia, type Bochdalek, and a situs inversus totalis for which contralateral cannulation for the institution of venoarterial ECMO (VA-ECMO) was warranted. A girl with a birth weight of 3810 g, born at the postmenstrual age of 39 + 6 weeks, developed acute respiratory distress, cyanosis, and lethargy within 30 minutes after birth. Physical examination revealed a scaphoid abdomen and decreased breathing sounds at the right side of the thorax. A chest radiograph revealed that the heart and mediastinum were displaced to the left and that the right pleural cavity was filled with intestines (Fig 1). Ultrasound confirmed that the right hemithorax was almost completely filled with loops of intestine, mesenterial fat, and the spleen due … Address correspondence to Dick Tibboel, MD, PhD, Head Pediatric Surgical Intensive Care Unite, Erasmus MC-Sophia, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: illsley{at}chis.azr.nl

An unusual case of a neonate with absent pericardium, left-sided diaphragmatic hernia, and hepatic hemangioendothelioma is described. The posterolateral diaphragmatic hernia was successfully repaired, and agenesis of the pericardium did not interfere with cardiac function postoperatively. The hepatic tumour was a coincidental radiological finding, while liver function and the biochemical profile were normal. We also present a review of the literature on congenital absence of the pericardium and conclude that all cases should be screened for cardiac and hepatic anomalies.

The authors report the case of a 12-year-old girl who presented with a left-sided diaphragmatic hernia that was diagnosed after a pulmonary infection. CT scan confirmed a posterolateral diaphragmatic Bochdalek defect. The child underwent a thoracoscopic repair of the defect in 1997. The herniated contents included spleen, stomach, and intestine. The child was discharged from hospital the day after surgery. She has been followed up and is clinical and radiologically well.

Une enfant de 11 mois a ete hospitalisee en reanimation pediatrique pour fievre, vomissement et epanchement pleural gauche. Alors que l'opacification du grele etait normale, l'echographie abdominale, le scanner thoracique et surtout l'opacification colique ont conduit au diagnostic de hernie colique par l'orifice de Bochdalek. La revue de la litterature montre que la hernie diaphragmatique tardive contient tres rarement du colon mais plutot des anses greles. Les auteurs soulignent le risque d'erreur diagnostique car seule l'opacification colique peut affirmer le diagnostic. La place du scanner thoracique et de l'echographie est discutee

Bochdalek hernia is a congenital posterior diaphragmatic defect resulting from failure of the retroperitoneal canal membrane to fuse with the dorsal esophageal mesentery and the body wall. A recent computed tomography study indicated that these defects frequently can be identified on routine chest and abdominal images, and classified them as small, medium, and large, the large ones being identifiable on five or more contiguous axial scans consisting of 1-cm-thick sections. Although the overall prevalence of Bochdalek hernias is 6%, and that of bilateral hernias is 0.9%, to date only a few patients with unilateral or bilateral large hernias have been reported. This article describes an adult with asymptomatic, bilateral, large Bochdalek defects containing herniated retroperitoneal fat.

Anatomically, diaphragmatic agenesis (DA) represents the most extreme form of congenital diaphragmatic defects, but clinically it has not been defined separately from Bochalek's hernia (BH). Between 1986 and 1992, the authors treated 55 neonates who had diaphragmatic defects. Forty-eight of them presented within 24 hours of birth and comprised the study group. Seventeen neonates (35.4%) were found to have DA; the other 31 (64.6%) had BH. There were no differences in the maternal age, gestation course, gender ratio, birth weight, or incidence of co-existing congenital anomalies between the two groups. However, there were significant differences with respect to the incidence of antenatal diagnosis (76.4% for DA patients v 12.5% for BH patients; P = .0004), mean (+/- SD) Apgar scores at 1 (4.1 +/- 2.0 v 5.7 +/- 2.3; P = .034) and 5 minutes (5.5 +/- 2.7 v 7.6 +/- 2.2; P = .016), mean duration of preoperative stabilization (2.8 +/- 2.0 v 2.1 +/- 1.9 days; P = .044) and mean duration of postoperative respiratory support (27.7 +/- 13.6 v 9.3 +/- 8.0 days; P = .002). Complications occurred in all seven survivors of DA and in only four (19.0%) of 21 survivors of BH (P = .0008). The neonates with DA had a significantly poorer long-term survival rates (29.4% v 64.5%; P = .04). Diaphragmatic agenesis is a distinct clinical entity; its unique short-term and long-term problems require careful management.

This case report describes pleural empyema, caused by an intrathoracic ruptured stomach, in an adult patient with Bochdalek hernia. The possible complications and difficulties in diagnosing Bochdalek hernia in the adult are discussed.

The main symptom of the congenital diaphragmatic hernia (CDH) is the respiratory distress due to the pulmonary hypoplasia and the persistence of foetal pulmonary circulation. Sometimes the CDH appears outside of the neonatal period with respiratory symptoms, abdominal pain and seldom with intestinal obstruction. A case of CDH presenting with intrathoracic volvulus is reported. This case shows that tendency of delayed repair until the newborn has been recovered, require more attention because the good condition of the patient can be changed not only by the pulmonary hypoplasia and the persistence of the foetal pulmonary circulation but also by the symptoms of the intrathoracic gut complications.

The purpose of this study was to determine the prevalence and characteristics of adult Bochdalek's hernia in a large patient population.We retrospectively reviewed all abdominal CT scans obtained at our hospital in 1998. Patients in our study were identified through a keyword search of our database for "Bochdalek," "hernia," and "diaphragm." The individual patient studies identified were reviewed in a soft-copy format. We noted the location and side of the body on which the diaphragmatic hernia arose and the contents of the sac. We also performed a chart review for each patient included in the study, noting the patient's sex, age, and symptoms.Incidental Bochdalek's hernia was diagnosed in 22 patients (17 women, five men), which represents an incidence of 0.17% based on 13,138 abdominal CT reports we reviewed. The mean age of the patients was 66.6 years. None of the patients were symptomatic. Sixty-eight percent of the hernias were on the right side of the body, 18% were on the left side, and 14% were bilateral. Seventy-three percent contained only fat or omentum, whereas 27% had solid or enteric organ involvement including the spleen, small intestine, or large intestine.Bochdalek's hernia is not rare, and the incidence of Bochdalek's hernias that contain enteric tract is higher than previously reported. This incidence likely represents a conservative estimate because some Bochdalek's hernias may have been overlooked or unreported.

Bochdalek's hernia is a congenital hernia of the diaphragm, which is manifested in the early years of life. Its diagnosis is difficult and is based on barium studies. We present an adult patient with Bochdalek's hernia who exhibited a gastric volvulus. The patient had a history of intermittent abdominal pains. In this article, we analyze the diagnostic and therapeutic procedures, laying special emphasis on the importance of early diagnosis in the prevention of complications.

A 12-year-old girl who had had an operation for a posterolateral diaphragmatic hernia was admitted to the hospital because of enuresis. Physical examination and radiologic studies revealed the spleen behind the urinary bladder, left-sided hydronephrosis, and a high volume of residual urine. The hydronephrosis and residual urine resolved immediately following splenectomy.

Four unrelated cases of congenital diaphragmatic hernia associated with ipsilateral upper limb reduction defects were reported by McCredie and Reid in 1978 (J Pediatr 92:762–765). As contiguous segments of the cervical neural crest are involved in the development of diaphragm and arms, the authors suggested that an early injury to the cervical neural crest might be the common underlying pathogenesis. We describe here a further example of this malformation complex: a newborn with a left posterolateral diaphragmatic hernia associated with ipsilateral thumb hypoplasia. © 1992 Wiley-Liss, Inc.

Acute herniation through a posterolateral diaphragmatic defect is rare in adults. Two cases in which such herniation occurred by sudden inversion, a 29-year-old man and a 17-year-old girl, are presented. The symptoms, diagnosis and treatment are discussed.

Congenital diaphragmatic hernias are usually diagnosed in childhood. The clinical presentation in adult life is heralded by complications which are sometimes misdiagnosed. In Bochdalek hernia incarceration of stomach, pancreas, omentum, colon and spleen can occur with ischemic necrosis if time elapses. Treatment demands surgical repair of the diaphragmatic defect and sometimes total or partial resection of abdominal organs, so an abdominal approach is preferable.

Diaphragmatic agenesis is a severe form of congenital diaphragmatic hernia for which an autosomal recessive form of inheritance has been proposed. The authors report six families with 13 pregnancies with diaphragmatic agenesis in which inheritance followed an autosomal recessive pattern, including the first reported case of bilateral diaphragmatic agenesis in twins. None of the thirteen affected fetuses survived. Familial diaphragmatic agenesis appears to be a distinct clinical entity with a worse prognosis than posterolateral diaphragmatic hernia.

We describe an infant with severe eventration of the right diaphragm and pulmonary hypoplasia who presented like a newborn with congenital diaphragmatic hernia complicated by persistent pulmonary hypertension. Surgical correction while on extracorporeal life support was unsuccessful due to attachments of the liver which prevented reduction into the abdominal cavity and our inability to distinguish the true defect from complete agencies of the right hemidiaphragm. At autopsy the pulmonary remnant and the fibrous membrane separating it from the liver were identified.

Hernias of the diaphragm are unusual defects that can present difficult diagnostic and technical problems for the surgeon (Figure 15–1). The entity of the hernia of the thoracic diaphragm was first recognized several centuries ago. Ambroise Pare (1510–1590) first described traumatic diaphragmatic hernia in 1579 based on postmortem findings in two patients [1]. In 1769, Giovanni Battista Morgagni described herniation through the subcostostemal space [2]. This same hernia would later be referred to as Larrey’s hernia [3] and descriptively known as the subcostosternal diaphragmatic hernia [4]. The posterolateral diaphragmatic hernia (foramen of Bochdalek) was described in 1848. Hiatal hernia has been recognized in autopsy studies for several centuries. Hiatal hernia was not diagnosed in living humans until early in the twentieth century following the development of diagnostic radiographic methods [5]. The technique and timing of repair of these diaphragmatic defects has been an area of controversy for many years. Recently, laparoscopic techniques have been applied to the repair of hernias of the diaphragm.

This report describes the laparoscopic approach of closure of a congenital left posterolateral diaphragmatic hernia in a 6-month-old boy. The pros and cons of such an approach are discussed.

A case report of a congenital posterolateral diaphragmatic hernia in an adolescent is presented and a technique for thoracoscopic repair of Bochdalek hernia is described. Postoperative discomfort was minimal and the hospital stay was less than 24 hours. Video-assisted thoracic surgery may be the technique of choice for repair of certain congenital diaphragmatic hernias when identified after infancy.

We report on a child with congenital bilateral cervical lung herniation with associated retrosternal (Morgagni), posterolateral (Bochdalek), esophageal hiatal, and inguinal herniae, and with multiple urinary bladder diverticuli. These multiple herniations may be secondary to a defect in the embryonic celomic mesoderm.

Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic hernia repaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.

The purpose of this article is to review the computed tomographic (CT) and related radiographic findings of adult Bochdalek hernias. Bochdalek hernias are one of the most common congenital abnormalities encountered in imaging studies of the chest and abdomen. CT can be used to confidently diagnose Bochdalek hernias, which can easily mimic neoplasms on other imaging studies.

PubMedID: 8064271 Bochdalek hernia is rare in adulthood with fewer than 100 cases having been reported in the world literature. We present a delayed case of Bochdalek hernia in an adult leading to sudden death, first diagnosed at medicolegal autopsy.

An asymptomatic case of a Bochdalek hernia with progressive herniation of the right ureter is presented. The diagnosis was made by computed tomography (CT).

WOS: A1994NY09600026 PubMed ID: 8064271 Bochdalek hernia is rare in adulthood with fewer than 100 cases having been reported in the world literature. We present a delayed case of Bochdalek hernia in an adult leading to sudden death, first diagnosed at medicolegal autopsy.

A 41-year-old man presented with acute onset of left chest pain. The pain was dull and decreased in severity upon sitting. There was no history of trauma. The initial chest radiograph showed an increased density at the left lung base suggestive of an effusion (Figure 1). A computed tomography (CT) scan of the chest revealed an oval-shaped, fat-dense mass in the left posterolateral pleural space with some vessels in the mass (Figure 2). A chest magnetic resonance imaging (MRI) scan confirmed the presence of a defect in the left hemidiaphragm through which there was herniation of the omentum into the posterior portion of left thoracic cavity (Figure 3). Subsequently, the patient underwent a left thoracotomy to repair the defect. A 6-cm long posterolateral diaphragmatic defect was identified with omentum herniating through the opening. No hernia sac was present. Because of no history of trauma, Bochdalek hernia was diagnosed. After lysis of adhesions between the omentum and the rim of the defect, the omentum was put back into the peritoneal cavity and the diaphragmatic defect was closed with interrupted nonabsorbable sutures. The postoperative course was uneventful, and the patient is still well 5 years after the operation without any radiographic evidence of recurrence. Congenital diaphragmatic Bochdalek hernia results from incomplete closure of pleuroperitoneal folds during embryonic development of the diaphragm, and becomes evident in the neonatal period because of its large size. Such a large Bochdalek hernia occurs in one of every 2,500 live births and is nine times as common on the left as on the right (1). It is extremely rare in adults, but may Figure 1. Chest radiograph demonstrating increased density at the left lung base.

Bochdalek hernia is a posterolateral defect in the embryogenesis of the diaphragm. Abdominal contents enter the thorax during fetal development and result in pulmonary hypoplasia. A cause of respiratory distress in the newborn, the management of this disease has undergone dramatic changes. The defect requires surgical repair, but success depends more on preoperative and postoperative management of the associated physiologic derangements.

A rare case of a patient with right-sided diaphragmatic hernia during pregnancy is described. Knowledge of this disorder offers the possibility of early diagnosis on clinical, ultrasound, and radiographic criteria before serious complications develop. Operative correction must be performed, with timing dependent on clinical presentation and period of gestation.

This report describes a premature (29 weeks gestation) infant with a left Bochdalek's diaphragmatic hernia, in whom the development of a spontaneous ipsilateral tension pneumothorax caused complete reduction of the hernia into the abdomen. In the presence of a tension pneumothorax, a diaphragmatic hernia may be masked on a chest radiograph and therefore difficult to diagnose.

We report a case of a 7-year-old-girl with a late-presenting Bochdalek hernia. The postoperative course was complicated by splenic torsion and subsequent total splenic infarction. Total splenic infarction due to splenic torsion has been reported in children with "wandering spleen" and in incarcerated Bochdalek hernias, but to our knowledge, not as a postoperative complication of Bochdalek hernia repair.

La dilatation segmentaire de l'intestin est une affection tres rare de telle sorte que 50 cas environ ont seulement ete rapportes dans la litterature internationale. L'auteur presente un cas de dilatation segmentaire de l'ileon, observee chez un nouveau-ne opere de hernie diaphragmatique congenitale. Les principaux aspects cliniques et la pathogenie sont discutes. La theorie d'une dysplasie ganglionnaire responsable de la dilatation segmentaire de l'intestin est confirmee

This report describes the simultaneous occurrence of a posterolateral diaphragmatic hernia and a congenital partial pericardial defect, a combination that has not been described previously.