[Congenital diaphragmatic adult hernia. Case report].
BACKGROUND
Bochdalek's hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side. It appears frequently in infants and is rare in adults. Diagnosis is incidental or when it becomes symptomatic. Our objective was to offer the general surgeon a differential diagnosis for presence of noncardiac thoracic pain in the adult.


METHODS
We present the case of a 78-year-old female with cardiorespiratory and digestive symptoms of slight intensity and managed for many years as hypertensive cardiopathy and dyspeptic syndrome until she was admitted to our service with severe epigastric pain. Postero-anterior x-ray of the thorax demonstrated the presence of the stomach in the thoracic cavity. This was confirmed by barium esophagogram, upper gastrointestinal endoscopy and abdominal CT scan where porcelain gallbladder was also detected. The patient underwent abdominal surgery where a large diaphragmatic hernia was found with the complete stomach and small bowel inside. Primary repair of the diaphragm and cholecystectomy were performed, confirming gallbladder cancer.


CONCLUSIONS
It is frequent that thoracic pain in patients of advanced age is interpreted as cardiac and/or digestive pathology and that more diagnostic investigation is not pursued due to patient age and invasive nature of the studies. Therefore, patients are treated according to their symptoms. It is important that the surgeon establishes an etiological diagnosis in order to offer appropriate treatment.


CONCLUSIONS
Congenital diaphragmatic hernia in the adult is rarely suspected in the differential diagnosis of noncardiac thoracic pain. The surgeon must keep this in mind, especially in patients of advanced age, even when cardiac and/or gastrointestinal diagnosis is confirmed.
Robledo-Ogazón
Felipe
F
Servicio de Cirugía General y Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., Mexico. faro@att.net.mx
Vargas-Rivas
Adriana
A
Hernández-Ramírez
Daniel Alejandro
DA
Castellanos-Juárez
Juan Carlos
JC
D017668:Age of Onset; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002637:Chest Pain / Q000209:etiology*; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D003371:Cough / Q000209:etiology; D003951:Diagnostic Errors; D004415:Dyspepsia / Q000175:diagnosis; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000209:etiology; D006331:Heart Diseases / Q000175:diagnosis; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D033162:Incidental Findings; D008171:Lung Diseases / Q000175:diagnosis; D014057:Tomography, X-Ray Computed