Intrathoracic appendicitis within a left-sided Bochdalek hernia: a case report

TL;DR

A rare case of acute appendicitis within a left-sided Bochdalek hernia in an adult is reported, emphasizing the importance of accurate diagnosis and timely surgery.

Contribution

This is the first reported case of acute appendicitis within a left-sided Bochdalek hernia in an adult.

Findings

Computed tomography was crucial for diagnosing appendicitis within the diaphragmatic hernia.

Emergency laparotomy with appendectomy and hernia repair led to a successful recovery.

The case highlights the diagnostic challenges of thoracic presentations of abdominal conditions.

Abstract

Bochdalek hernias are rare congenital defects usually diagnosed in infancy, and their presentation in adults is uncommon. Even rarer is the occurrence of acute appendicitis within a Bochdalek hernia; to date, only two adult cases have been reported, both involving right-sided or unspecified hernias. We describe a 21-year-old previously healthy man who presented with sudden left-sided chest pain and mild respiratory symptoms. Imaging identified a left posterolateral diaphragmatic hernia containing bowel loops and an inflamed appendix. He underwent emergency laparotomy with appendectomy and primary repair of the diaphragmatic defect without mesh due to contamination risk. Histopathology confirmed acute suppurative appendicitis. The patient’s recovery was uneventful, and he remained well at follow-up. This case underscores the diagnostic challenge posed by atypical thoracic presentations of abdominal pathology and highlights the critical role of computed tomography in enabling timely surgical intervention.

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