Bochdalek hernia associated with intestinal malrotation as an incidental finding in an adult patient: case report

Bochdalek hernia (BH) is the most common congenital diaphragmatic hernia, however in adults the clinical presentation and diagnosis is rare. Intestinal malrotation (IM) is a congenital anomaly that results in an alteration in intestinal anatomy secondary to inadequate intestinal rotation, which occurs at the end of the first trimester of embryonic development, some digestive anomalies may be related, such as diaphragmatic hernia, its Diagnosis is made in the neonatal period although it can be diagnosed in older children and adults, debuting with symptoms of intestinal obstruction or being an incidental finding. Below we present a case report of an adult patient with a diagnosis of Bochdalek congenital diaphragmatic hernia (CDH) in whom an incidental diagnosis of IM was made, who underwent elective surgery, performing laparoscopic diaphragmatic plasty with favorable results

Bowel obstruction secondary to type IV hiatal hernia: a case report

Hiatal hernias are classified into four types. Type 4 hernias are not limited to the stomach alone, but involve herniation of the omentum, colon, small intestine, peritoneum, pancreas, or spleen into the chest cavity. Account for less than 5% of all cases. The probability that a patient with a paraesophageal hernia will develop acute symptoms and require emergency surgery is 1.16% per year. We present a case of acute paraesophageal hiatal hernia repair in a patient who developed large bowel obstruction. An 82-year-old female was admitted to emergency room referring abdominal distension, intolerance to the oral intake, vomiting of fecal content, as well as impossibility to pass gas or evacuate. On physical evaluation with tachycardia and acute abdomen, laboratory studies showed leukocytosis, radiographic data of intestinal obstruction, and at the level of the left hemithorax, space occupation by the colon was evident. An emergency surgery was performed finding paraesophageal hernia with involvement of the stomach and transverse colon, and retrograde dilatation of the ascending and transverse colon with ischemic changes. The patient presented hemodynamic instability, so an extended right hemicolectomy was decided, with distal closure, ileostomy, and hiatal plasty performed. She was discharged on postoperative day four without complications. Type 4 hiatal hernia complicated with intestinal obstruction is a condition that carries high rates of morbidity and mortality, so early surgery is mandatory to avoid a fatal outcome for the patient. There are currently no clear guidelines regarding the management of acute complicated paraesophageal hernias