Emergency laparoscopic repair of an obstructed Bochdalek hernia in an adult.

A previously fit 27-year-old man presented to the authors' casualty department with a 24-hour history of severe vomiting, dizziness and lethargy. Examination was unremarkable except for marked dehydration. The patient was found to be hypokalaemic (K+ 2.8 mmol/litre) and in acute renal failure (urea 16.8 mmol/litre, creatinine 259 ¼mol/litre). After admission the patient became pyrexial and began to vomit uncontrollably. Chest auscultation revealed decreased air entry at the left lung base and the chest radiograph was reported as showing cystic bronchiectasis for which antibiotic therapy was commenced (Figure 1). The abdominal radiograph showed a paucity of intestinal gas. Upper gastrointestinal endoscopy to investigate the hyperemesis demonstrated an extremely dilated stomach containing 3 litres of fluid, with reflux oesophagitis. Computed tomography scans displayed a small left lung, a dilated stomach and herniation of abdominal viscera into the left side of the chest, with an empty abdominal cavity. Lap...