Abstract
Bochdalek hernias are rarely diagnosed in adults and account for 0.17-6% of all diaphragmatic hernias. It is a congenital diaphragmatic hernia caused by a defect in the posterior attachment of the diaphragm due to a failure of the pleuroperitoneal membrane closure in utero. This may rarely cause chest pain, respiratory symptoms, or gastrointestinal symptoms. In this study, we present a case of a laparoscopic paraesophageal repair via Nissen fundoplication. The incidental finding and subsequent repair of a Bochdalek hernia during this case may have resulted in complications of the surgery including pneumothorax due to the defect in the pleuroperitoneal membrane.
Highlights
Bochdalek hernias are very rare, accounting for 0.17-6% of all diaphragmatic hernias [1]
We report a case of an incidental Bochdalek hernia found during repair of a paraesophageal hernia with Nissen fundoplication
Bochdalek hernia is a type of congenital diaphragmatic hernia that occurs due to the failure of closure of the pleuroperitoneal folds causing a defect in posterolateral diaphragmatic formation [7]
Summary
Bochdalek hernias are very rare, accounting for 0.17-6% of all diaphragmatic hernias [1]. A laparoscopic Nissen fundoplication with hiatal hernia repair with crural mesh reinforcement was discussed with the patient and he consented to the surgery. The peritoneum was dissected away from the hiatus and the dissection was carried across the midline anteriorly to the left At this point, a secondary defect in the diaphragm was found, which was determined to be a 4 cm x 2 cm Bochdalek hernia with an incarcerated cardia and 12 cm hernia sac. The patient was discharged to an intensive care unit for continued medical management of the pneumothorax and subsequently discharged from the hospital after two days with instructions to slowly advance diet consistency over the month and avoid exertion He was last seen in a follow-up in clinic two weeks later, where he reported resolution of his GERD with appropriately healing abdominal incisions
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