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Case Reports in Medicine
Volume 2010, Article ID 296730, 4 pages
http://dx.doi.org/10.1155/2010/296730
Case Report

Intrathoracic Caecal Perforation Presenting as Dyspnea

1Service des Soins Intensifs, Cliniques Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10 1200, Brussels, Belgium
2Service de Radiologie, Cliniques Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10 1200, Brussels, Belgium
3Service de Chirurgie et Transplantation Abdominale et service des Urgences, Cliniques Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10 1200, Brussels, Belgium

Received 14 July 2010; Revised 29 November 2010; Accepted 21 December 2010

Academic Editor: Gerald S. Supinski

Copyright © 2010 Vincent Granier et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.