title: Association of intestinal malrotation and Bochdalek hernia in an adult: a case report.
abstract: BACKGROUND
  Late presentations of congenital diaphragmatic hernia are rare and differ from the classic neonatal presentation. The association with other congenital malformations in children, mainly intestinal malrotation, is well documented. The diagnosis of this association in adults is very rare, and depends on a high degree of suspicion.
  
  
  METHODS
  We report a case of a 50-year-old female Caucasian patient with a previous history of intestinal malrotation diagnosed in adolescence and treated conservatively. She was referred to the hospital with signs and symptoms of intestinal obstruction. The patient undertook computed tomography that confirmed small bowel obstruction with no obvious cause, and a right subphrenic abscess with right empyema was also present. An exploratory laparotomy was performed that revealed an intestinal malrotation associated with a right gangrenous and perforated Bochdalek hernia. Resection of the affected small bowel, closure of the Bochdalek foramen and the Ladd procedure were carried out.
  
  
  CONCLUSIONS
  This case shows a rare association of two rare conditions in adults, and highlights the challenge in reaching the diagnosis and management options.
authors.forename: Raquel
authors.initials: R
authors.lastname: Salústio
authors.affiliation: Department of Surgery, Hospital de São José, Centro Hospitalar de Lisboa Central, Serviço de Cirurgia 1, Rua José António Serrano, 1150-199 Lisboa, Portugal. celso.nabais@gmail.com.
authors.forename: Celso
authors.initials: C
authors.lastname: Nabais
authors.forename: Bárbara
authors.initials: B
authors.lastname: Paredes
authors.forename: Francisco V
authors.initials: FV
authors.lastname: Sousa
authors.forename: Eusébio
authors.initials: E
authors.lastname: Porto
authors.forename: Caldeira
authors.initials: C
authors.lastname: Fradique
mesh_terms: D000328:Adult; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D045822:Intestinal Volvulus / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult