Laparoscopic management of acute presentations of obstructed, congenital, diaphragmatic hernias in adults: case reports

Abstract

: Congenital diaphragmatic hernia (CDH) occurs in 1/2,500 neonates. Hernia of Bochdalek accounts for 6%; hernia of Morgagni for 3%. Our case reports highlight the unusual, acute presentation of CDH in adults, outline diagnostic process and discuss laparoscopic techniques that can be used by surgeons faced with these rare cases. Early papers suggest presence of less than 100 reported cases of symptomatic Bochdalek and Morgagni type hernias in adults. Due to limited available evidence, the need to share successes and failures of surgical techniques used is greater than ever. Case reports here discuss successful laparoscopic techniques that can be used. Hernia of Morgagni presented in a 62 years old gentleman with acute abdominal pain and signs of obstruction on CT. Hernia of Bochdalek presented in a 50 years old lady with acute abdominal pain and vomiting, with obstruction on CT. Laparoscopically, reduction of Morgagni hernia was followed by partial reversal of hernial sac—step where controversies exist in literature. Mesh repair of defect presented challenges. Primary closure of defect was performed for Bochdalek hernia owing to its smaller size, followed by tension pneumothorax—not an uncommon occurrence. Acute, uncomplicated cases of CDH in adults can be successfully managed with emergency laparoscopic surgery. Although there is lack of standardisation currently on best surgical technique, we found good results with reduction followed by primary closure of diaphragmatic defect and use of mesh repair in case of a larger defect.