Dear Dr. Roach: I was diagnosed with a Bochdalek hernia following a lung CT scan I had for a separate problem. I had had some pretty serious pain a few months earlier, and went to the doctor, but nothing was found at that time. It wasn鈥檛 until later, when I had the CT scan, that the hernia suddenly showed up. I then saw a surgeon, and he said that surgery could be postponed since I had no symptoms, it appeared that the hernia was fat-filled and there was no movement of my abdominal organs into the thoracic cavity. I didn鈥檛 have any symptoms again until this month, and now I am planning to go back and see the surgeon. It has been very difficult to try to find information on the Internet that might help me to make a decision about whether to have the surgery. A friend of mine who is a doctor said that there is a risk that the abdominal organs could push up through the hernia, which can be a life-threatening issue. From what I understand, this condition is so rare in adults that very few surgeons have ever seen it. I believe it is more commonly found in infants.听 Can you weigh in about this type of hernia?
T.M.L.
A Bochdalek hernia is fairly common in newborns (1 in 2,500 or so), and usually is treated surgically within a few days of birth. It is caused by a lack of development of the diaphragm, allowing abdominal contents (stomach, small or large intestine, spleen) to move into the chest. This potentially can prevent the lungs from developing.
They are rare in adults. A 2010 case report identified about 150 adult cases found in the world鈥檚 literature, but noted that as more people undergo CT scanning for other issues, more cases will be identified.
I have never seen a case. From what I have read, most people are treated surgically. The pain you had certainly might have been related to the hernia. Symptoms include chest and abdominal pain, shortness of breath and intestinal obstruction. Finding a surgeon with expertise in this issue may be difficult, but I would start at a teaching hospital nearby if you want a second opinion. However, what the surgeon you consulted said makes sense to me.
听
Dear Dr. Roach: You mentioned in a column that you don鈥檛 recommend high-school football because of the injury rates. Will you please write about the toxins in artificial turf that our students must play on?
P.D.
There are more than a few reasons to be concerned about artificial turf. I have read about the chemical composition of the crumb rubber used in the construction of artificial turf, and there are several chemicals (such as lead) that pose health risks. However, at the level the athletes are exposed to, the risks appear to be low. 听
Given the high temperatures that artificial surfaces can reach and keeping in mind that some of the athletes who play on these surfaces are quite young, I am concerned that after many years of use the research evaluating their safety is not definitive. In addition, abrasion injuries seem to be more common with artificial turf, and the research on more serious injuries is mixed.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
