Bochdalek hernia with retrocardiac spleen - Diagnostic dilemma for emergency care physicians—A case report

• Published in: International journal of surgery case reports 2020-01, Vol.71, p.364-366
• Main Authors: Khan, Liaqat A., Al-Neami, Ali M., Soliman, Ayman F., Khaled, Alaa A.M., Tawhari, Mohammed I.H., Athlawy, Yahya A.
• Format: Article
• Language: English
• Subjects: Bochdalek; Diaphragm; Emergency care; Hernia; Physician; Retrocardiac; Spleen
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.03.051

•Bochdalek Hernia is most commonly found in young age.•Bochdalek Hernia may present in old age with non-specific symptoms.•ER Physicians and surgeons should be critical in thinking keeping such unusual pathology in mind while dealing with patients.•New ER Physicians commonly miss such rare and unusual cause of abdominal and thoracic symptoms. Physicians working as first-level responders in emergency departments (ED) often encounter patients, of any age group with shortness of breath (SOB). Definitive diagnosis is quite challenging once the underlying pathology is rare and unusual and/or the ED physicians recommend and rely on non-specific investigations. A 29-year-old female presented to the emergency department with sudden onset of shortness of breath and upper abdominal pain radiating to the left shoulder. Diagnosis of Bochdalek hernia was made clinically coupled with radiological findings of CXR and computed tomography (CT) by the surgeon on-call, while it was missed by an emergency care physician on her first visit. Herniation of the abdominal contents into the thoracic cavity via the Bochdalek opening, commonly known as Bochdalek hernia is seen and diagnosed most commonly accidentally in early life. Adult cases of symptomatic Bochdalek hernia has been reported in the literature. These patients usually present with non-specific symptoms, thus pose a diagnostic challenge for an emergency care physician. The report of this case highlights the notion that such rare causes of acute onset dyspnea and upper abdominal pain pose a diagnostic challenge for novice emergency care physicians especially in situations where he/she does not ask for second-line help in general and recommend and rely on a non-specific investigation in specific.