BOCHDALEK HERNIA IN ADULTS: A CASE SERIES OF A RARE DEFECT

Abstract

Diaphragmatic hernias are more common among neonates and infants. Smaller defects may remain asymptomatic in childhood and present later in adult life. Congenital diaphragmatic hernias in adults are usually asymptomatic or may present with symptoms arising due to mass effect on the lungs and/or due to dysfunction of herniated organs. The omentum and transverse colon commonly appear in the herniated sac. However, larger defects in the diaphragm may also cause other parts of the intestine, spleen, and kidney (of either side) to herniate into the thoracic cavity. We present a case series of three adults with left-sided Bochdalek hernia, which was noted as an incidental finding. The size of the defects in the left hemidiaphragm in all the cases were large enough, 74.0mm, 57.0mm and 62.0mm respectively, to cause significant herniation of abdominal structures. During the operative treatment, we preferred the abdominal approach in all the cases: in case one and three for better reduction of organs and repair of the large defect; and in case two as obstruction of the bowel was suspected. The defect in case one and three was repaired by mesh reinforcement while in case two, a primary repair of the defect was done with sutures followed by fixation of mesh over it. Congenital diaphragmatic hernia in adults almost always necessitates surgical repair of the defect to avoid complications like strangulation or incarceration of the herniated structures.