Bochdalek Hernia Research Articles

Asymptomatic Bochdalek Hernia in Adults on CT scan

Asymptomatic Bochdalek Hernia in Adults on CT scan

S5057 Mesenteroaxial Volvulus Complicated by Gastric Perforation in an Elderly Patient With Bochdalek Hernia

S5057 Mesenteroaxial Volvulus Complicated by Gastric Perforation in an Elderly Patient With Bochdalek Hernia

Gastric Volvulus in Association with Bockdalekhernia in Adult Patient (Case Report)

Purpose: Bochdalek hernia (BH) in adulthood is rare. Symptomatic BH in adults is rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency.Materials and Methods: A 22-year-old male patient presented to our emergency department with a two-day history of severe epigastric pain. The pain was dull in nature with dyspnea on lying supine. Findings: The stomach was within the thorax on the left side due to left diaphragmatic hernia of a nontraumatic cause, diagnosed by chest radiograph, and computed tomography (CT). The patient was prepared for the open surgical repair, to close the defect. The patient recovered with accepted general condition and was discharged 5 days later. In conclusion, in our case, we report this rare presentation of BH with gastric volvulus as an urgent condition that needs to be diagnosed as early as possible to prevent fatal complications. Implications to Theory, Practice and Policy: A diagnosis of an adult diaphragmatic hernia should always be kept in mind in patients with overlapping abdominal and respiratory symptoms with or without a history of trauma.

Wandering Spleen Complicated by Thrombocytopenia, Acute Appendicitis, and Sepsis: A Case Report and Literature Review

Wandering spleen (WS) is a rare condition often linked with torsion or infarction, but its association with Bochdalek hernia, acute appendicitis, and thrombocytopenia is exceptionally rare. We present a case of a nine-year-old girl who was admitted with acute abdominal pain, later diagnosed with WS, Bochdalek hernia, and acute appendicitis. A literature search was performed on PubMed and Google Scholar on 30 May 2024 with keywords including “Wandering spleen” and (“Bochdalek Hernia” OR “Sepsis” OR “Acute Appendicitis” OR “Thrombocytopenia”). The management was complicated by severe thrombocytopenia and post-operative sepsis, with Klebsiella pneumoniae as the causative agent. Imaging revealed an abnormally located spleen and significant splenic enlargement over time. The patient’s condition was managed non-operatively concerning the WS, avoiding splenectomy due to the risks of post-splenectomy sepsis. Instead, laparotomy was performed to address the appendicitis and diaphragmatic hernia. The patient experienced post-operative complications, including a seizure and persistent fever, which resolved with appropriate antibiotic therapy. This case underscores the complexity of managing WS with concurrent severe conditions, highlighting the importance of individualised treatment strategies. It also emphasises the need for further studies to explore optimal treatment modalities for such rare and complex presentations. This case serves as an educational example in clinical settings, demonstrating the challenges and considerations when treating multiple rare pathologies simultaneously.

805. BOCHDALEK HERNIA - CASE REPORT

Abstract Introduction Bochdalek hernia is a rare type of diaphragmatic hernia congenital and is quite uncommon in adulthood, representing only 0.17-6% of all diaphragmatic hernias. The objective of the present study is to report the technique surgery performed on a patient with a bochdalek hernia. Methods The information was obtained through medical record review, interview with the patient and literature review. Results/Discussion A 49-year-old female patient was admitted to a hospital in Natal (RN- Brazil) with vomiting for seven months, average of 3-4 vomits daily after meals, associated with dysphagia, epigastric pain and weight loss of 26 kg during this period. The physical examination, she was dehydrated, emaciated and with a flaccid abdomen and painless. Laboratory exams, she presented high levels of ureia and hypokalemia. CT scan of the chest and abdomen with contrast showed a hernia right posterolateral diaphragm with insinuation of the transverse colon and portion distal part of the stomach, in addition to significant gastric stasis, without signs of ischemia. Vigorous hydration was carried out and fasting was maintained, in addition, was inserted nasogastric tube and began parenteral nutrition. After ten days of parenteral nutrition and correction of hydro electrolyte disorders, there was an improvement in symptoms with laboratory normalization. So, she undergo a surgical intervention by videolaparoscopy. Surgical intervention took place with the pneumoperitoneum with Veress needle and trocars inserted (2 10-inch trocars). mm and 3 of 5 mm). Introduction of 30° optics. Cavity inventory identified massive right posterolateral diaphragmatic hernia, containing transverse colon and part of the stomach. Hepatic retractor was positioned to retracted the right hepatic lobe. Completely reduced the hernia through the Bochdalek foramen, after undoing content adhesions with the diaphragm. Afterwards, the closing of the defect with 2-0 Ethibond thread and a biocompatible mesh placed over the suture (Phasix) 10x10 cm and fixed with the same thread in separate stitches. Left drain blake type number 24 Fr, was left in the right hemithorax. The procedure was done uneventful. Conclusions Bochdalek hernia is a structural defect in the diaphragm, which can cause the passage of practically any intra-abdominal organ to the chest. Surgical repair of the defect is the only existing treatment option. In this case, we have a late presentation and in a complicated form. We opted for clinical stabilization of the patient, with nutrition and timely videolaparoscopy on the tenth day of hospitalization. The correction of hernia laparoscopically allows wide access to the workplace and with good mobility for dissection of the hernial sac, in addition to unquestionable acceleration of postoperative recovery and reduction of surgical trauma and size of the incisions. This way, we have a shorter hospitalization time with early return to the patient's daily activities.

Late presentation of Bochdalek hernia in children – experience at a single centre

Late presentation of Bochdalek hernia in children – experience at a single centre

Operative management of traumatic rupture of diaphragma in elderly with Bochdalek hernia: a rare case report

Operative management of traumatic rupture of diaphragma in elderly with Bochdalek hernia: a rare case report

Right-Sided Bochdalek Hernia Associated with Group B Streptococcal Sepsis in a Preterm Neonate.

We report here a compelling case of a premature female newborn who was originally treated for breathing difficulties that arose a few hours after delivery. The initial chest radiograph showed no abnormalities, and the blood culture detected sepsis caused by group B streptococcus (GBS). The antibiotic treatment was modified accordingly. Later on, she experienced a gradually increasing opacification in the right side of her chest, which did not respond to medical treatment. A subsequent imaging examination conducted a few days later indicated the presence of a hernia in the right side of the diaphragm. The neonate, who was 14 days old, received surgical intervention to fix the abnormality in the diaphragm. The procedure was successful, and there were no complications during the postpartum period. This case report aims to emphasize the distinctive correlation between early-onset GBS sepsis and the postponed occurrence of right-side diaphragmatic hernia.

Multidisciplinary follow-up in a patient with Morgagni hernia leads to diagnosis of Marfan syndrome

Backgroundcongenital diaphragmatic hernia (CDH) is a birth defect occurring in isolated or syndromic (chromosomal or monogenic) conditions. The diaphragmatic defect can be the most common one: left-sided posterolateral, named Bochdalek hernia; or it can be an anterior-retrosternal defect, named Morgagni hernia. Marfan syndrome (MFS) is a rare autosomal dominant inherited condition that affects connective tissue, caused by mutations in fibrillin-1 gene on chromosome 15. To date various types of diaphragmatic defects (about 30 types) have been reported in association with MFS, but they are heterogeneous, including CDH and paraesophageal hernia.Case presentationWe describe the case of a child incidentally diagnosed with Morgagni hernia through a chest X-ray performed due to recurrent respiratory tract infections. Since the diagnosis of CDH, the patient underwent a clinical multidisciplinary follow-up leading to the diagnosis of MFS in accordance with revised Ghent Criteria: the child had typical clinical features and a novel heterozygous de novo single-base deletion in exon 26 of the FBN1 gene, identified by Whole-Exome Sequencing. MFS diagnosis permitted to look for cardiovascular complications and treat them, though asymptomatic, in order to prevent major cardiovascular life-threatening events.ConclusionOur case shows the importance of a long-term and multidisciplinary follow-up in all children with diagnosis of CDH.

Case Report: The Diaphragmatic Hernia: A Rare Cause of Intestinal Obstruction

We present the case of a 22-year-old patient, with congenital diaphragmatic hernia, diagnosed at an advanced stage due to an occlusive syndrome observed on the CT scan, revealing colonic distension upstream of a strangulated Bochdalek's diaphragmatic hernia. The patient underwent laparotomy, where the hernia was reduced, and the diaphragmatic rupture was closed. The purpose of this article is to highlight a rare cause of intestinal obstruction, which is strangulated diaphragmatic hernia, when the diagnosis and detection of complications are confirmed through CT scan, allowing for early management.

Enhancing diaphragmatic defect repair and regeneration: How biomaterials leading the way to progress?

AbstractPhysicians encounter significant challenges in dealing with large diaphragmatic defects in both pediatric and adult populations. Diaphragmatic hernias, such as Morgagni, Bochdalek, and Hiatus hernias, can result in congenital lesions that are often undiagnosed until the appearance of symptoms (bleeding, anemia, and acid reflux). Therefore, substantial potential exists for developing tissue‐engineered constructs as novel therapeutic options in clinics. Recent research indicates promising mid‐term performance for both natural and synthetic materials. However, studies exploring their application in diaphragm regeneration are limited and remain in the early research stages. Additionally, further investigation is required to address the constraints in human tissue supply for clinical implementation. This article comprehensively reviews the role of biomaterials in diaphragmatic tissue repair and regeneration. It emphasizes biomaterials, including biomimetic polymers used in technological solutions. This summary will enable researchers to critically assess the capability of existing natural biomaterials as essential tissue‐engineered patches for clinical use.

Abdominal viscera in the thoracic cavity: a case of large Bochdalek hernia in an adult

Introduction: Bochdaleck hernias (BH) are a congenital defect in the diaphragm's postero lateral part that may cause the abdominal viscera's protrusion into the chest cavity. This type of hernia is rare in adults. Most cases are referred to the emergency department with gastrointestinal obstruction and visceral strangulation symptoms. Case presentation: A 50-year-old man was referred to the emergency department complaining of abdominal pain in the left upper quadrant, intermittent vomiting, and pain in the left hemithorax from one day ago. We found a large diaphragmatic hernia on the left side during evaluation, which causes intra-abdominal organ shift to the left hemithorax. The patient underwent surgery for diaphragmatic herniorrhaphy. Conclusion: Congenital diaphragmatic Bochdaleck hernias are rare and are associated with nonspecific symptoms in adults. They may be symptom-free during the patient's life as in our case. It is necessary to investigate more cases and long-term follow-ups of patients, to improve the diagnosis and treatment of these patients.

Diaphragmatic Hernia (Bochdalek Hernia) in an Adult: a Case Report

Bochdalek hernia (BH) is the most common type of congenital diaphragmatic hernia and constitutes 85% of cases. In adults BH is extremely rare. Most of them are asymptomatic. We present a case of BH in an adult patient to point out the importance of clinical examination and computed tomography (CT) scan in reaching the exact diagnosis. A 17-year-old male was presented to the surgery department with a 3-days history of recurrent abdominal pain, vomiting and unable to lie flat. The BH was confirmed on computed tomography (CT) imaging and the patient underwent emergency laparotomy and per-operatively we found part of stomach, greater omentum, splenic flexure of colon along with spleen herniated into the left hemithorax through a defect of approximately 8x6cm in the left postero-lateral aspect of the diaphragm. Reduction of hernia contents and surgical repair of the defect was done with non-absorbable suture. His post-operative period was uneventful. Although rare, this disorder should be recognized and treated appropriately to avoid complications. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 64-67

Late presentation Bochdalek hernia complicated by mesentero-axial volvulus

A 5 year old with a history of recurrent chest infections and presumed asthma presented to the emergency department with acute severe abdominal pain, tachycardia and pallor. Chest radiograph done to exclude pneumoperitoneum demonstrated a large gas filled structure occupying the majority of the left hemithorax. This was superimposed with several tubular gas filled structures. CT showed a large left-sided diaphragmatic hernia of the Bochdalek type containing the pancreas, stomach, small bowel loops, small bowel mesentery with vessels and lymph nodes and some large bowel. Associated left pulmonary hypoplasia was present. In addition, the stomach was significantly dilated with an ‘upside down’ configuration. It’s antrum and pylorus were above the diaphragm and gastro-oesophageal junction while its fundus and proximal body were below the diaphragm, appearances in keeping with mesentero-axial volvulus, necessitating urgent surgical management.

Incidental finding of Bochdalek hernia in an adult: acasereport.

A Bochdalek hernia, also known as a congenital diaphragmatic hernia (CDH), is a type of hernia that occurs in infants. The diaphragm, the muscle that separates the chest cavity from the abdominal cavity, is characterized by a hole or gap during birth. This opening allows the abdominal organs, such as the stomach, intestines, or liver, to pass through the thoracic cavity. Here, we report a 56-year-old male patient who came to our hospital because of rectal bleeding, symptoms unrelated to the hernia. We performed a Computed Tomography (CT) scan with contrast enhancement to find the cause of the bleeding and as an incidental finding we diagnosed the hernia: it is very rare to find a silent Bochdalek hernia for more than 50 years.

Report of a case of bochdalek hernia in an adult presenting as chronic cough: review of literature and discussion

Adult symptomatic bochdalek hernias (BH) are rare and account for 0.16%-6% of all diaphragmatic hernias. Chronic abdominal pain is commonest type of presentation. We have a patient of BH presented with chronic cough and breathlessness on exertion. Aim was to study clinical course and outcome of patient presented to our institute. We also would like to review relevant literature available online and compare it with our findings. 30-year-male from peripheral area had recurrent episodes of cough and breathlessness on exertion since 7 years. He was treated as a case of lower respiratory tract infection. We did chest radiogram which revealed presence of haziness in left lower zone with obliteration left costophrenic angle. His computerized tomography scan revealed defect of approximate size 43×45 mm in posterolateral aspect of left hemidiaphragm with omental herniation. Patient was operated by lap converted to open primary bochdalek hernia repair. His postoperative course was uneventful. Review of literature done revealed cough as a rare type of presentation. Laparoscopy is becoming emerging modality of treatment to do surgical correction. Adult onset diaphragmatic hernias have variable clinical manifestations. High index of clinical suspicion with imaging studies like contrast enhanced computed tomography (intravenous plus oral contrast) of chest and abdomen are required for timely diagnosis and treatment.

Bochdalek Hernia: A Comprehensive Review of Pathophysiology, Clinical Presentation, Diagnostic Modalities, and Contemporary Management Strategies

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

Ultrasound Diagnosis of Congenital Diaphragm Hernia And Successful Outcome After Postnatal Surgery

Background: Congenital diaphragmatic hernia (CDH) is a disorder where abdominal contents protrude into the chest. Congenital diaphragmatic hernias are seen in 1 of every 2000-4000 live births. Mortality is predominantly due to the development of pulmonary hypoplasia which is thought to be due to the mass effect on the developing lung.Case Report:Mrs. Y, a 32-year-old controlled for antenatal care at the fetomaternal polyclinic M Djamil hospital. She had no complaints, the patient was referred from another hospital with a suspected fetal diaphragm hernia. The patient is known to be 38-39 weeks term pregnancy, from ultrasound examination found herniation of abdominal contents into the thoracic cavity and. the liquor was excessive and the doppler study was normal. The ultrasound showed normal growth and corresponded to 38 week Then the patient was planned for caesarean section and a hernia repair surgery. The neonate was admitted to the neonatal intensive care unit (NICU). He was shifted to the pediatric surgeon with ventilator support after 48 h and was undergoing surgery. There was a posterolateral left sided defect (BOCKDALEK type) of around 22–24 mm. The intestines were reduced to the abdomen and the closure was done. Immediately after the surgery, the child was admitted back to the NICU and the further postnatal course was uneventful.Discussion and Conclusion: CDH is a malformation of the diaphragm due to failure of closure of the pleuroperitoneal canal at around 10 weeks leading to herniation of abdominal contents into the thoracic cavity leading to compression of lung tissues at pseudo glandular stage. CDH is often ultrasound diagnosed before birth [120, 121]. The intestine and/or the liver may be in the thorax and the lungs are small. US scan allows detailed assessment of the heart. The survival depends on the contralateral lung volume, Ninety percent of cases are due to posterolateral defect which is also called Bochdalek hernia—80% are left sided, 15% are right sided and 5% are bilateral. Herniated viscera leads to pulmonary hypoplasia and pulmonary hypertension. Prognosis depends on the gestational age at diagnosis (earlier the diagnosis, likely larger the defect), associated anomalies, contralateral lung volume, pulmonary vasculature (Doppler), cardiac function, liver herniation and gestational age at delivery

Conservative approach in adult right-sided Bochdalek hernia with an intrathoracic ectopic kidney

Bochdalek hernia (BH) is a congenital diaphragmatic defect primarily diagnosed in neonates and is usually left-sided. Adult diagnosis, especially of right-sided BH is exceedingly rare and usually presents with symptoms. Till now, only 31 cases have been diagnosed to be right-sided BH along with intrathoracic kidney. This report presents a 26-year-old asymptomatic male who was incidentally diagnosed with a massive right congenital diaphragmatic hernia. Imaging revealed severe abdominal herniation, a right intrathoracic ectopic kidney, and a right liver lobe hypoplasty along with hypertrophied left liver lobe extending down to the pelvic cavity. Several surgeons were consulted, with controversial opinions on whether elective surgery should be performed or withheld. Due to the high risk associated with surgery and the patient’s choice, the surgery was deferred. For almost 18 months, the patient did not report any symptoms or complications. This case highlights the rarity of asymptomatic right-sided BH in adults and the challenges in determining a management approach. Also, it proposes a conservative approach for such patients as a management modality. Most extensive diagrammatic defect reported is estimated to have a neck defect of 10 cm. Most BH cases have been treated surgically and reports on the outcome of a conservative approach are exceedingly rare. In such cases, patient preferences and a thorough risk assessment play vital roles in decision-making regarding conservative versus surgical approaches.

An Adult Male with Bochdalek Hernia– A Case Report

Bochdalek hernia results due to failure of pleuroperitoneal membranes to fuse completely before birth, resulting in a defect in left posterior diaphragm through which abdominal organs can herniate into thorax. It is a congenital condition and is common in infants and children. It is rarely present in adults. We present a case of a twenty five year old adult male presenting with a 2 day history of sharp epigastric and left hypochondriac pain and 1 month history of non-bloody, non-projectile vomiting. An X-ray Abdomen was done showing signs of small bowel obstruction (SBO) with eventration of diaphragm and mediastinal shift. Upon surgical approach, a Bochdalek hernia defect was seen in left posterolateral diaphragm. Patient was successfully treated with laparotomy and mesh repair without any perioperative and postoperative complications.