Laparoscopic repair of colonoscopy-induced adult Bochdalek hernia: Case report

Introduction: Bochdalek hernias are congenital diaphragmatic malformations caused by a failure to close the pleuroperitoneal cavity in the posterolateral area. Bochdalek hernias are very rare in adult, with congenital diaphragmatic defects being even rarer. Presentation of case: A 35-year-old man presented to our emergency room with epigastric pain after colonoscopy. The patient had no history of trauma. Plain chest X-ray revealed bowel gas patterns and haziness in the left lower lung field. Abdominal computed tomography revealed a left diaphragmatic defect in the posterolateral area, with herniation of the omentum and colon. The patient successfully underwent laparoscopic herniorrhaphy. Discussion: The diaphragm comprises fibrous tissue and muscle. Therefore, direct damage by a colonoscope is almost impossible. Normal chest X-ray as a part of a health screening was performed 9 days prior to admission, and the size of the diaphragmatic defect could be covered by the spleen; therefore, the patient was considered hernia-free for over 30 years. Conclusion: We report a rare case of delayed Bochdalek hernia that may have been induced by the difficult insertion of a colonoscopy. Although rare, this disorder should be recognized, examined and treated appropriately to avoid complications.