Bochdalek Hernia as a Discrepant Intraoperative Diagnosis in a Paraesophageal Hernia Surgery: A Surgical Case Report

Bochdalek hernia (BH) is a rare paediatric condition, but late diagnoses occur in adults. It occurs following incomplete posterolateral development of the diaphragm. Adult BH is asymptomatic in most cases, but it has the potential of being life-threatening. This case report is of a 35-year-old female patient who presented to us with a history of childhood abdominal discomfort leading to frequent hospitalisation. Presently, she came with complaints of increasing abdominal pain, postprandial vomiting, and a 31% weight loss over 3 months before the current admission to our facility. A preoperative diagnosis of a Type IV hiatus hernia with a possible volvulus was made with the assistance of radiology, which turned out to be left BH intraoperatively. Only the herniated stomach was laparoscopically reduced due to technical difficulties and pexied along the defect to seal it. The postoperative period was unremarkable. This case report highlights the need for maintaining a high index of suspicion and surgical preparedness for BH in patients with high-grade hiatus hernia.