Bochdalek Hernia Research Articles

Bochdalek hernia in an adult patient in the disguise of hydropneumothorax - A diagnostic interrogation

Congenital diaphragmatic hernias are most common postero laterally which are called as Bochdalek hernias. They are very rare to occur in adults. Here we present a case of 50-year-old male who presented with acute respiratory distress with suspected diagnosis of hydropneumothorax which was later confirmed as left sided Bochdalek hernia. The defect was surgically repaired using a PTF mesh, after returning the contents of hernia into abdomen. This communication emphasizes the need to detect diaphragmatic hernia disguised as hydropneumothorax to avoid fatal complications.

Strangulated Bochdalek Hernia: Approach of Management in Emergency Setting

Strangulated Bochdalek Hernia: Approach of Management in Emergency Setting

Fortuitous Discovery of a Bochdalek Hernia in an Adult

Bochdalek hernia is the most common type of congenital diaphragmatic hernia. It is due to a defect in the posterior attachment of the diaphragm muscle, subsequent to a failure of pleuroperitoneal membrane closure in utero. Bochdalek hernia is often asymptomatic in adults, hence, it is fortuitously discovered as an incidental finding on CT scan. Alternatively, it may be diagnosed only after complications occur, such as empyema, cardiac tamponade and gastrointestinal strangulation. CT usually demonstrates a fatty mass above the diaphragm (Figure 1: arrow), which may be associated with other organs entrapment. Coronal and sagittal reformatted images show the diaphragmatic defect (Figure 2: arrows).

Single incision laparoscopic repair for late-onset congenital diaphragmatic hernia using oval-shaped multichannel port device (E•Z ACCESS oval type)-2months infantile case of Bochdalek hernia.

Late-onset congenital diaphragmatic hernia constitutes 10%-36% of congenital diaphragmatic hernias. They qualify for endoscopic treatment including both thoracoscopic and laparoscopic approaches because this type of patient is in relatively stable condition compared with neonatal cases. However, single incision laparoscopic approach has not been reported. We herein report an infantile case of late-presenting diaphragmatic hernia who underwent single incision laparoscopic repair using an oval-shaped multichannel port device. A 2 month old female infant had sudden onset dyspnea with cyanosis and was diagnosed as having left diaphragmatic hernia (Bochdalek hernia) by chest X-ray. As her respiratory condition became stable under conservative treatment using combination of decompression of the gastrointestinal tract and mild sedation, we electively planned laparoscopic repair. Preoperative enhanced computed tomography imaging found that herniated organs were stomach, spleen, pancreatic tail, small intestine and right colon. The patient also had an umbilical hernia, so we decided to perform single incision repair through this umbilical hernia. Three trocars were introduced using an oval-shaped multichannel port device and herniated organs were reduced by gentle manipulation. The defect of the diaphragm was closed by bi-hand needle driving for upper and lower limb using a stay suture. The umbilical hernia was also repaired. Postoperative course was uneventful and no recurrence was recognized. Wider trocar separation was achieved using the oval-shaped device, making the needle driving easier to perform. By using an oval-shaped multichannel port device and ingenuity of needle driving, single incision repair of infant diaphragmatic hernia was enabled.

Endoscopic pilonidal sinus disease treatment (EPSiT).

The purpose of this image is to illustrate a Bochdalek hernia diagnosis in a 39-year-old female patient treated on an emergency basis by means of CT-scan and following perioperative observation. Treatment consisted in initial laparoscopy that due to irreducible bowel incarceration was converted into hernia repair surgery through simple suture and thoracic drainage.

Concurrent Morgagni and Bochdalek congenital diaphragmatic hernias with omphalocele

Abstract Congenital diaphragmatic hernia (CDH) is a well-documented developmental abnormality in the formation of the diaphragm, resulting in herniation of bowel into the thorax causing pulmonary hypoplasia. CDH has been associated with many genetic syndromes and other anatomic anomalies including craniofacial, cardiac, skeletal, brain, ocular, renal, and abdominal wall defects. Despite this, co-occurrence of CDH and omphalocele is rare and only identified within 0.63% of neonates with CDH. Most congenital diaphragmatic hernias are located posterolateral (Bochdalek hernias) or anterior retrosternal or parasternal (Morgagni hernias); bilateral diaphragmatic hernias are rare. We describe the first documented case of concurrent Bochdalek and Morgagni hernias with an omphalocele and no other associated anatomic anomalies.

Right-sided Bochdalek hernia associated with an intrathoracic kidney in an adult

A 37-year-old, morbidly obese (body mass index: 47.5) woman with Down syndrome, severe mental impairment, and institutionalization was referred to the outpatient surgery unit of our institution by her primary care physician owing to an asymptomatic ventral hernia. There was no history of abdominal trauma, and she reported no gastrointestinal or urinary symptoms. A physical examination revealed a painless giant ventral hernia with loss of domain.

“NOT AT HOME” !!!

A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiaphragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of foetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. Incidental diagnosis in an asymptomatic patient presenting in adult life is rare. We report a case of an asymptomatic eighteen year old male who was incidentally discovered to have congenital diaphragmatic hernia when he was operated for testicular torsion on an emergency basis.

Laparoscopic repair of massive Bochdalek hernia

Bochdalek hernias are a rare diaphragmatic hernia, usually diagnosed in childhood. We report a case of a large Bochdalek hernia containing omentum, stomach, left colon and some small bowel (jejunum) including mesentery, the superior pole of the left kidney, spleen and tail of pancreas diagnosed in adulthood. Our patient underwent a laparoscopic repair of this massive hernia with a composite mesh with an excellent post-operative outcome.

A Rare Case of Symptomatic Bochdalek Hernia in 58-years-Old Male

A Rare Case of Symptomatic Bochdalek Hernia in 58-years-Old Male

A Case of Adult Right Sided Bochdalek Hernia Needed Emergency Operation with Bowel Obstruction

A Case of Adult Right Sided Bochdalek Hernia Needed Emergency Operation with Bowel Obstruction

Fatal Outcome in a Right Bochdalek Hernia with Renal Ectopia Diagnosed in Adulthood

Diaphragmatic hernias may be acquired or congenital. Among congenital hernias, the most common is Bochdalek hernia and eight out of ten Bochdalek hernias occur on the left side. They are usually diagnosed in the paediatric age group, and it is exceedingly rare for the diagnosis to be established in adulthood. Renal ectopy associated with a Bochdalek hernia is extremely rare, and very few cases are reported worldwide. We are reporting a case of a 73-year-old male patient with a right-sided Bochdalek hernia and renal ectopy. In this case, promp diagnosis and treatment could help to reduce the high risk of death in this kind of patients.

Bochdalek Hernia in an Adult Presenting as Hydropneumothorax due to Gastric Volvulus Perforation: A Case Report

Bochdalek Hernia in an Adult Presenting as Hydropneumothorax due to Gastric Volvulus Perforation: A Case Report

Right strangulated bochdalek hernia in a 65-year-old and repair with laparotomy approach

Right strangulated bochdalek hernia in a 65-year-old and repair with laparotomy approach

A Case of Intestinal Obstruction Caused by Intestinal Malrotation After Repair of a Bochdalek Hernia in an Adult−A Case Report−

A Case of Intestinal Obstruction Caused by Intestinal Malrotation After Repair of a Bochdalek Hernia in an Adult−A Case Report−

A rare Case of Right Sided Bochdalek Hernia Co-existing with Intrathoracic Kidney

A rare Case of Right Sided Bochdalek Hernia Co-existing with Intrathoracic Kidney

Right Sided Bochdalek Hernia with Ureteric Involvement – A Case Report and Review of Management Options

Ureteric herniation through a diaphragmatic defect in adults (Bochdalek hernia – BH) is rare, with less than 15 cases reported in the literature. Most patients present with non-specific abdominal symptoms with or without worsening of renal function, and therefore, the clinical picture can be masked [1]. Management of ureteric involvement ranges from conservative to reconstructive surgery. We report a case of an elderly (>80-year-old) patient who presented acutely with symptoms mimicking an acute abdomen and on imaging was found to have a BH associated with herniation of right ureter causing hydro-ureter. We managed the patient conservatively, and she improved symptomatically, which was evident from her follow-ups. We provide a detailed case report of this situation as well as discuss the literature on the topic to guide treatment decision-making.

A rare cause of cholestasis: Congenital right diaphragmatic hernia

An 82-day-old infant, investigated for sudden onset jaundice and acholic feces, was referred to our department, as no gallbladder was observed by abdominal ultrasonography. Her chest x-ray revealed an elevated right diaphragm, and the breath sounds were diminished on the right. Suspicious arteriovenous malformation in the fifth segment of the right lobe accompanied by a rotation anomaly of liver was reported. Tomography scans showed right diaphragmatic hernia where the left lobe of liver and gallbladder herniated to the thoracic space. In this case with right Bochdalek hernia, the bile ducts had kinked in the thoracic cavity, causing obstructive jaundice. If the kinking continues despite relocation of organs into the abdominal cavity, cholecystectomy-hepaticojejunostomy is an effective and reliable surgical method. Myriad pathologies may cause cholestasis, and surgical reasons should be investigated and diagnosed without delay to improve prognosis. For closure of the diaphragmatic defect, primary repair should be the preferred method. With this case, we wanted to emphasize a highly different presentation of Bochdalek hernia and remind that diaphragmatic hernia should be kept in mind in patients presenting with cholestasis and acholic stools.

Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan

BackgroundA Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear.Case presentationA 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up.ConclusionA recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

A rare clinical entity of asymptomatic adult bochdalek hernia

Bochdalek hernia (BH) is the commonest congenital diaphragmatic hernia, caused by the failure of the posterolateral diaphragmatic foramina to fuse properly. It is extremely rare in adults and accounts for 5-10%. Presenting a case of 48 years female with complaints of dry cough and left chest pain for 1 week. Diminished breath sounds and abnormal gurgling sounds heard on auscultation of left chest wall. X-ray chest showed elevated left hemi diaphragm and gastric bubble. Computed tomography (CT) chest revealed left diaphragmatic hernia with splenic flexure, transverse colon, mesocolon, spleen and upper pole of left kidney as content and atelectasis of left lung lower lobe. Patient underwent laparoscopic repair of hernia with mesh plasty. Intraoperatively, the contents were reduced into the abdominal cavity and left lung expansion noted. The defect of size 6×10 cm in the left diaphragm was sutured and composite mesh placed. Post-operative chest x-ray showed expanded left lung. On follow up of patient after 2 weeks and 1 month, patient was asymptomatic. BH in adults is an uncommon. The contents can be reduced via thoracic or abdominal approach, with abdominal approach having easier access. With the advent of minimal access techniques, delineating clear anatomy, more working space, early recovery, and early return to home and work is possible. Thus, laparoscopic repair of adult diaphragmatic hernia is a safe and effective modality of surgical treatment.