Khan Liaqat A, Al-Neami Ali M, Soliman Ayman F, Khaled Alaa A M, Tawhari Mohammed I H, Athlawy Yahya A
Department of General and Laparoscopic Surgery, Sabya General Hospital, Ministry of Health, Jazan, Saudi Arabia.
Department of Radiology, Baish General Hospital, Ministry of Health, Jazan, Saudi Arabia.
Int J Surg Case Rep. 2020;71:364-366. doi: 10.1016/j.ijscr.2020.03.051. Epub 2020 May 14.
Physicians working as first-level responders in emergency departments (ED) often encounter patients, of any age group with shortness of breath (SOB). Definitive diagnosis is quite challenging once the underlying pathology is rare and unusual and/or the ED physicians recommend and rely on non-specific investigations.
A 29-year-old female presented to the emergency department with sudden onset of shortness of breath and upper abdominal pain radiating to the left shoulder. Diagnosis of Bochdalek hernia was made clinically coupled with radiological findings of CXR and computed tomography (CT) by the surgeon on-call, while it was missed by an emergency care physician on her first visit.
Herniation of the abdominal contents into the thoracic cavity via the Bochdalek opening, commonly known as Bochdalek hernia is seen and diagnosed most commonly accidentally in early life. Adult cases of symptomatic Bochdalek hernia has been reported in the literature. These patients usually present with non-specific symptoms, thus pose a diagnostic challenge for an emergency care physician.
The report of this case highlights the notion that such rare causes of acute onset dyspnea and upper abdominal pain pose a diagnostic challenge for novice emergency care physicians especially in situations where he/she does not ask for second-line help in general and recommend and rely on a non-specific investigation in specific.
在急诊科担任一级响应人员的医生经常会遇到任何年龄组出现呼吸急促（SOB）的患者。一旦潜在病理情况罕见且不寻常，和/或急诊科医生推荐并依赖非特异性检查，明确诊断就颇具挑战性。
一名29岁女性因突发呼吸急促和放射至左肩的上腹部疼痛就诊于急诊科。值班外科医生通过临床诊断并结合胸部X线（CXR）和计算机断层扫描（CT）的影像学检查结果确诊为博赫dalek疝，而急诊医生在其首次就诊时漏诊。
腹腔内容物通过博赫dalek孔疝入胸腔，即通常所说的博赫dalek疝，在生命早期最常见于偶然发现和诊断。文献中已报道有成人症状性博赫dalek疝病例。这些患者通常表现为非特异性症状，因此给急诊医生带来诊断挑战。
该病例报告强调了这样一个观点，即这种急性起病的呼吸困难和上腹部疼痛的罕见病因给新手急诊医生带来诊断挑战，尤其是在他们一般不寻求二线帮助且在特定情况下推荐并依赖非特异性检查的情况下。
