Acute Bowel Obstruction in a Giant Recurrent Right Bochdalek's Hernia: A Report of Complication on Both Sides of the Diaphragm

Late presentation of a congenital problem; complicated left-sided Bochdalek's hernia in an adult: A case report

Background

A diaphragmatic hernia is a defect or hole in the diaphragm through which abdominal contents can enter the chest cavity. Diaphragmatic hernias may be congenital (Morgagni hernia, Bochdalek hernia), a hiatal hernia, or acquired (iatrogenic and traumatic). Bochdalek's hernia typically occurs on the left side and rarely occurs in adults. Less than 100 cases of left Bochdalek's hernia in adults have been described in the literature. Most of them are asymptomatic.

Case report

We report a complicated left Bochdalek hernia in a 43-year-old adult male who is a smoker. He came to the pulmonary clinic with symptoms and signs of pneumonia of the left lower lobe with persistent dyspeptic symptoms. Chest radiography revealed evidence of a left diaphragmatic hernia, which was confirmed by computed tomography of the chest and abdomen, and subsequently treated by left diaphragmatic repair via limited left thoracotomy.

Conclusion

We report a rare case of a left Bochdalek hernia in an adult who underwent an appropriate left thoracotomy. Bochdalek hernias in adults are rare and usually asymptomatic, but when they become symptomatic, surgical intervention is required to avoid complications. BH should be considered in the differential diagnosis when radiographs suggest pneumothorax and should be treated early to avoid complications.

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

BACKGROUND

Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable.

METHODS

A bibliographic search using major databases was performed using the terms "emergency surgery" "diaphragmatic hernia," "traumatic diaphragmatic rupture" and "congenital diaphragmatic hernia." GRADE methodology was used to evaluate the evidence and give recommendations.

RESULTS

CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients.

CONCLUSIONS

Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

Left sided flank pain due to Bochdalek hernia with intrathoracic kidney

A 40 year old woman had undergone surgery as a newborn due to a left sided congenital Bochdalek hernia with the ventricle, spleen, left kidney and adrenal gland located intrathoracically. After three pregnancies, she developed left sided flank pain and dyspnea. A CT scan showed a diaphragmatic hernia with a malrotated intrathoracic placed left kidney with minimal hydronephrosis. The spleen was located caudally in the left iliac fossa; there were no other abnormalities. The patient underwent a thoracotomy with a small resection of the diaphragm in order to replace the kidney in the abdominal cavity and closure of the diaphragmatic defect with a Gore-Tex patch.

Emergency surgery due to diaphragmatic hernia: case series and review

Background

Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17–6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.

Methods

From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.

Results

Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.

Conclusion

Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.

Cytoreductive Surgery Followed by Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Cancer with Incidental Bochdalek Hernia and Postoperative Bilateral Thalamic Infarct: A Case Report

Congenital Bochdalek hernia is a defect of the diaphragm and very rare in adults. Only around 100 cases have been reported in the literature. Herein, we present a case with a recurrent ovarian cancer who underwent secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. An oval defect with dimensions of 3 × 4 cm was seen in the left posterolateral site of the diaphragm during surgical exploration. In addition, a 6 × 3 cm iatrogenic right-sided diaphragmatic defect was found and repaired. In the early postoperative period, a bilateral thalamic infarction occurred.