Congenital diaphragmatic hernia in the adult.

Diaphragmatic hernia through pleuroperitoneal canal of Bochdalek in the adult is a rare surgical occurrance. Two adult males 26 and 43 years of age with left sided hernia of the foramen of Bochdalek with abdominal viscera in the thoracic cavity were treated in North Surgical Unit. The major part of the contents in both cases consisted, of greater omentum and transverse colon whereas in one patient the thoracic cavity also contained portions of stomach and jejunum. These patients were admitted as emergency with acute upper abdominal symptoms and respiratory embarrassment which was more marked in one patient who had been misdiagnosed as a case of tension pneumothorax and treated by an intercostal drainage tube at a peripheral hospital before he was referred to us. This patient in fact was later found to have a perforation in the transverse colon which was lying in the chest cavity. In the adults these invariably present us emergency due to strangulations of the herniated contents. The diagnosis is often missed because of the rarity of the condition, although the need for an urgent and accurate diagnosis is imperative for correct management. The chest X-Rays in these patients tell the whole story provided they are looked at carefully (JPMA 36: 16, 1986).