Intrathoracic Caecal Perforation Presenting as Dyspnea

الملخص EN

Introduction.

Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults.

Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult.

Case Presentation.

A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever.

Five days before, she had been experiencing an episode of diffuse abdominal pain.

The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift.

Chest tube drainage was purulent.

The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect.

At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum.

Ileocaecal resection was performed, but the patient died from delayed septic complications.

Conclusion.

Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.