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Huang YJ, Fang YL. Robot-assisted congenital diaphragmatic hernia repair in adults: A case series. Medicine (Baltimore) 2024; 103:e39918. [PMID: 39470520 PMCID: PMC11521093 DOI: 10.1097/md.0000000000039918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/10/2024] [Accepted: 09/13/2024] [Indexed: 10/30/2024] Open
Abstract
RATIONALE Congenital diaphragmatic hernia (CDH) is a rare condition predominantly affecting neonates, with only a few cases remaining undetected until adulthood. Surgical repair is the primary treatment approach for adults with confirmed CDH. Traditionally, these procedures include laparotomy, thoracotomy, and minimally invasive techniques such as thoracoscopy and laparoscopy. However, only a few cases of robotic diaphragmatic hernia repair have been reported in recent decades. PATIENT CONCERNS The patients, aged 31 and 71 years, presented with atypical symptoms of chest tightness and fever. Imaging studies revealed a left-sided Bochdalek CDH in 1 patient and a right-sided Morgagni CDH in the other. DIAGNOSES The patients were diagnosed as CDH in adult with different symptoms. INTERVENTIONS Both patients received robot-assisted diaphragmatic hernia repair at our institution. OUTCOMES The patients received robotic-assisted diaphragmatic hernia repair with acceptable surgery outcome and safety. There was no complication or recurrence. LESSONS This case series indicates that the robotic transabdominal approach for CDH repair in adults can be an optimal minimally invasive approach for selected patients, demonstrating adequate surgical safety and favorable outcomes.
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Affiliation(s)
- Yu-Jen Huang
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yue-Lin Fang
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Farwati R, Ghedda SA, Aboudan R, Ataya J, Abdulhakim H. Bochdalek's hernia in adults: A unique case with gastric volvulus and intrathoracic kidney. Int J Surg Case Rep 2024; 121:110006. [PMID: 38972105 PMCID: PMC11277729 DOI: 10.1016/j.ijscr.2024.110006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION AND IMPORATNCE Introduction: Bochdalek's hernia (BH) is a congenital diaphragmatic hernia predominantly diagnosed in the pediatric population but infrequently found in adults. This paper presents a unique case of an adult patient with a left-sided BH accompanied by gastric volvulus and an intrathoracic kidney. CASE OF PRESENTATION A 21-year-old male presented with abdominal pain and vomiting. An MDCT scan revealed a twisted stomach, spleen, and kidney herniated into the chest due to left diaphragmatic eventration. Surgery involved untwisting the stomach, relocating the organs, and removing the hernia sac. DISCUSSION Bochdalek hernias (BHs) are rare conditions in which abdominal organs move into the chest due to defects in the diaphragm. BH usually occurs on the left side and can be triggered by factors such as pregnancy, obesity, or trauma. Symptoms can vary from abdominal pain to chest discomfort, and diagnosis can be challenging. Imaging tests such as CT scans are essential for accurate diagnosis. In adults, the BH can contain various organs, such as the spleen and kidney. Rarely, BH can be associated with an ectopic kidney located inside the chest cavity. In some cases of BH, there is a risk of complications such as gastric volvulus, where the stomach twists on itself, leading to potentially serious symptoms such as severe abdominal pain and vomiting. CONCLUSION This case underscores the severe risks of BH in adults, such as gastric twisting and blockage, necessitating urgent surgery. Timely diagnosis and surgical intervention are crucial for preventing life-threatening outcomes. More research is needed to improve the management of this rare condition.
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Affiliation(s)
- Reem Farwati
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | | | - Rama Aboudan
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Hassan Abdulhakim
- Consultant General Surgery, Sheikh Khalifa Medical City Ajman, Ajman, United Arab Emirates
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Granados Flores AA, Arriola Rios DI, Gonzalez Soto JR. Incarcerated Bochdalek Hernia in Adults. Cureus 2024; 16:e61422. [PMID: 38947577 PMCID: PMC11214721 DOI: 10.7759/cureus.61422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
In this case report, the diagnostic challenge and emergency management of a Bochdalek hernia in adults in Mexico are outlined. This case report can help the medical community to consider the clinical presentation in adults and the importance of early diagnosis and management. We present a 57-year-old female patient with a history of arterial hypertension who, following a bout of abdominal pain, was diagnosed with a Bochdalek hernia. Following emergency surgery, there was an increase in intra-abdominal pressure, which was continuously monitored due to the possibility of compartment syndrome, potentially necessitating a second emergency surgery.
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Yagishita Y, Kano Y, Takamori M, Tawara M, Iwanami S, Ibe M, Murata K, Araki J, Watanuki S, Kuki T, Kitazono M. Bochdalek Hernia Causing Sigmoid Colon Strangulation in an Elderly Patient. Intern Med 2024; 63:447-450. [PMID: 37316276 PMCID: PMC10901714 DOI: 10.2169/internalmedicine.1793-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Diaphragmatic hernia with bowel strangulation is a fatal condition requiring a prompt diagnosis. Bochdalek hernia is a common type of diaphragmatic hernia that rarely but occasionally occurs in adults. We herein report a case of Bochdalek hernia causing sigmoid colon strangulation in an elderly patient whose condition was initially misdiagnosed as empyema. The early diagnosis of strangulated bowel stemming from diaphragmatic hernia can be challenging because of its rarity and the nonspecificity of its symptoms. However, tracing the mesenteric arteries on computed tomography can enable a quick diagnosis.
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Affiliation(s)
- Yuika Yagishita
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
- Department of Respiratory Medicine and Oncology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Mikio Takamori
- Department of Respiratory Medicine and Oncology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Mari Tawara
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Satoru Iwanami
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Masaaki Ibe
- Department of Respiratory Medicine and Oncology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Kengo Murata
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
- Department of Respiratory Medicine and Oncology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Junko Araki
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Satoshi Watanuki
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Takaie Kuki
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Miyako Kitazono
- Department of Respiratory Medicine and Oncology, Tokyo Metropolitan Tama Medical Center, Japan
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5
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Han XY, Selesner LT, Butler MW. Congenital Diaphragmatic Hernia. Surg Clin North Am 2022; 102:739-757. [DOI: 10.1016/j.suc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Katsaros I, Giannopoulos S, Katelani S, Vailas M, Sotiropoulou M, Papaconstantinou D, Giannakodimos I, Kapetanakis EI, Tomos P, Schizas D. Bochdalek hernias in the adult population: a systematic review of the literature. ANZ J Surg 2022; 92:2037-2042. [PMID: 35357073 DOI: 10.1111/ans.17651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bochdalek hernia (BH) is characterized by the protrusion of viscera into thorax through the posterolateral section of the diaphragm. The aim of this study was to systematically review current literature concerning Bochdalek hernias in adults and elucidate their clinical characteristics and preferable treatment approach. METHODS A search of PubMed and Cochrane bibliographical databases for studies regarding BHs was conducted (last search: 31st March 2021). RESULTS Predefined inclusion criteria were met by 173 articles and concerned collectively 192 patients (50.5% males) with a mean age of 45.41 ± 20.26 years. Abdominal pain (62.0%) and pulmonary symptoms (41.1%) were the predominant symptomatology of included cases. BHs protruded mainly through the left side of the diaphragm (70.7%), with large intestine (42.7%) and stomach (37.1%) being the most commonly herniated abdominal organs. Most patients (53.8%) underwent an open surgical approach, while abdominal approach was preferred (64.8%). to the thoracic one. Thirty-day postoperative complication were encountered at 21.5% of patients, while 30-day mortality reached 4.4%. CONCLUSION BH is an extremely rare type of congenital diaphragmatic hernia. It rarely concerns adults, and it manifests with vague gastrointestinal or pulmonary symptoms. Surgical approach is the preferred method for their management with open procedures being preferable at emergency cases, while minimal invasive approach necessitates experienced centers. Further research is needed in order to clarify their true incidence and optimal therapeutic strategy.
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Affiliation(s)
- Ioannis Katsaros
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Giannopoulos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatia Katelani
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Vailas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Sotiropoulou
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Ayoub K, Swed S, Alibrahim H, Alswij MA, Alabdo S, Mhali N. An atypical presentation of a strangulated bochdalek hernia in a 60-year-old woman. Ann Med Surg (Lond) 2021; 71:102936. [PMID: 34729180 PMCID: PMC8545657 DOI: 10.1016/j.amsu.2021.102936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022] Open
Abstract
Bochdalek hernia (BH), resulting from the failure of posterolateral diaphragmatic foramina to fuse, is the most common congenital diaphragmatic hernia and usually manifests in pediatric age with life-threatening complications. Here, we report the case of a 60-year-old female with a left-sided Bochdalek diaphragmatic hernia, who presented with abdominal pain and dyspnea. The patient was successfully treated by open surgery approach but the patient died due to the lung doesnt expand after atelectasis in the third day after surgery. We know that a few cases of bochdalek hernia have been reported in the elderly by the medical literature, but what distinguishes our case is that the hernia was strangulated and the patient died as a result of non-expansion of the lung after its atelectasis following surgical repair. Bochdalek hernia is a rare conginital malformation in th eldery patients. The accurate method to diagnose Bochdalek is computed tomography. The management is surgical either open surgery or laparoscopic.
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Affiliation(s)
- Kusay Ayoub
- Department of General Surgery, University Aleppo Hospital, Aleppo, Syria
| | - Sarya Swed
- Faculty of Human Medicine, Aleppo University, Aleppo, Syria
| | | | | | - Shorouk Alabdo
- Department of Pediatrics, University Aleppo Hospital, Aleppo, Syria
| | - Nihad Mhali
- Department of General Surgery, University Aleppo Hospital, Aleppo, Syria
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Fanget F, Drevet G, Maury JM, Tronc F. Intestinal Air in the Mediastinum. Chest 2021; 160:e299-e303. [PMID: 34488972 DOI: 10.1016/j.chest.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 11/15/2022] Open
Abstract
CASE PRESENTATION A 74-year-old man, in excellent physical condition and doing regular intense cycling, was evaluated for transient episodes of thoracic discomfort over a period of several months. His medical history only included a right inguinal hernia, surgically treated, and an abdominal aortic aneurysm measured at 46 mm and treated medically. Physical examination did not reveal much information. The patient did not report gastroesophageal reflux, dysphagia, or history of digestive occlusion. The patient had normal weight and had no trauma history. He had no nicotine or alcohol-dependent behaviors. Vital signs were within normal values. Laboratory test results were normal. Functional status was normal, without anomalies of pulmonary function tests or arterial blood gases. The ECG did not reveal any anomaly.
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Affiliation(s)
- Florian Fanget
- Department of Digestive and Endocrine Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Gabrielle Drevet
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
| | - Jean-Michel Maury
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
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Enomoto N, Yamada K, Kato D, Yagi S, Wake H, Nohara K, Takemura N, Kiyomatsu T, Kokudo N. Right-sided Bochdalek hernia in an adult with hepatic malformation and intestinal malrotation. Surg Case Rep 2021; 7:169. [PMID: 34273029 PMCID: PMC8286215 DOI: 10.1186/s40792-021-01232-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bochdalek hernia is a common congenital diaphragmatic defect that usually manifests with cardiopulmonary insufficiency in neonates. It is very rare in adults, and symptomatic cases are mostly left-sided. Diaphragmatic defects generally warrant immediate surgical intervention to reduce the risk of incarceration or strangulation of the displaced viscera. CASE PRESENTATION A 47-year-old woman presented with dyspnea on exertion. Computed tomography revealed that a large part of the intestinal loop with superior mesenteric vessels and the right kidney were displaced into the right thoracic cavity. Preoperative three-dimensional (3D) simulation software visualized detailed anatomy of displaced viscera and the precise location and size of the diaphragmatic defect. She underwent elective surgery after concomitant pulmonary hypertension was stabilized preoperatively. The laparotomic approach was adopted. Malformation of the liver and the presence of intestinal malrotation were confirmed during the operation. The distal part of the duodenum, jejunum, ileum, colon, and right kidney were reduced into the abdominal cavity consecutively. A large-sized oval defect was closed with monofilament polypropylene mesh. No complications occurred postoperatively. CONCLUSION Symptomatic right-sided Bochdalek hernia in adults is exceedingly rare and is frequently accompanied by various visceral anomalies. Accurate diagnosis and appropriate surgical repair are crucial to prevent possible incarceration or strangulation. The preoperative 3D simulation provided comprehensive information on anatomy and concomitant anomalies and helped surgeons plan the operation meticulously and perform procedures safely.
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Affiliation(s)
- Naoki Enomoto
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kazuhiko Yamada
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Daiki Kato
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shusuke Yagi
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hitomi Wake
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoko Nohara
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Kelly M, Palamuthusingam P. Bochdalek herniation: an unusual cause of bowel obstruction in an adult. ANZ J Surg 2021; 91:E535-E536. [PMID: 33405301 DOI: 10.1111/ans.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Madeleine Kelly
- School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Pranavan Palamuthusingam
- Department of General Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Amin S, Irani S. EUS-guided gastroenterostomy for relief of obstructive symptoms in a patient with a large Bochdalek hernia. VideoGIE 2020; 5:655-657. [PMID: 33319133 PMCID: PMC7730137 DOI: 10.1016/j.vgie.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Giuliani D, Hoenjet K, Vaneerdeweg W, Tjalma W, Hubens G, Chapelle T, Eyskens E, Backer AD. Congenital Right-Sided Diaphragmatic Hernia in an Elderly Patient A Case Report. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D. Giuliani
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - K. Hoenjet
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - W. Vaneerdeweg
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - W. Tjalma
- Departments of Gynaecology-Obstetrics, University Hospital of Antwerp, Edegem, Belgium
| | - G. Hubens
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - T. Chapelle
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - E. Eyskens
- Departments of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - A. De Backer
- Departments of Radiology, University Hospital of Antwerp, Edegem, Belgium
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Miyasaka T, Matsutani T, Nomura T, Hagiwara N, Chihara N, Takahashi K, Mishima K, Taniai N, Yoshida H. Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan. Surg Case Rep 2020; 6:233. [PMID: 32990881 PMCID: PMC7524921 DOI: 10.1186/s40792-020-01003-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 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 PRESENTATION A 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. CONCLUSION A 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.
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Affiliation(s)
- Toshimitsu Miyasaka
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takeshi Matsutani
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. .,Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan.
| | - Tsutomu Nomura
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Naoto Chihara
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Koichi Takahashi
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Keisuke Mishima
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Nobuhiko Taniai
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Perrone G, Giuffrida M, Annicchiarico A, Bonati E, Del Rio P, Testini M, Catena F. Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. World J Surg 2020; 44:4012-4031. [DOI: 10.1007/s00268-020-05733-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
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15
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Gupta S, Warrell D, Smith L, Williams GL. Strangulated right-sided diaphragmatic hernia presenting and treated as lung empyema: beware of the differential diagnosis. BMJ Case Rep 2020; 13:13/7/e233440. [PMID: 32641313 DOI: 10.1136/bcr-2019-233440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old man with no surgical history or recent trauma presented to the emergency department with sudden onset right-sided chest pain and dyspnoea. He was admitted under the physicians for investigations and was subsequently diagnosed with empyema of the right thorax. After no improvement with intravenous antibiotics, a chest drain was inserted; no pus was drained. He worsened clinically; a repeated CT scan demonstrated an incarcerated loop of small bowel within the right thoracic cavity secondary to a diaphragmatic hernia (DH). The patient had emergency surgery to remove necrotic small bowel and to lavage the thorax. Strangulated DH should be considered as a differential diagnosis where presentation is unusual and empyema does not improve after initial management.
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Bochdalek hernia with retrocardiac spleen - Diagnostic dilemma for emergency care physicians-A case report. Int J Surg Case Rep 2020; 71:364-366. [PMID: 32506006 PMCID: PMC7276389 DOI: 10.1016/j.ijscr.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Physicians working as first-level responders in emergency departments (ED) often encounter patients, of any age group with shortness of breath (SOB). Definitive diagnosis is quite challenging once the underlying pathology is rare and unusual and/or the ED physicians recommend and rely on non-specific investigations. PRESENTATION OF CASE A 29-year-old female presented to the emergency department with sudden onset of shortness of breath and upper abdominal pain radiating to the left shoulder. Diagnosis of Bochdalek hernia was made clinically coupled with radiological findings of CXR and computed tomography (CT) by the surgeon on-call, while it was missed by an emergency care physician on her first visit. DISCUSSION Herniation of the abdominal contents into the thoracic cavity via the Bochdalek opening, commonly known as Bochdalek hernia is seen and diagnosed most commonly accidentally in early life. Adult cases of symptomatic Bochdalek hernia has been reported in the literature. These patients usually present with non-specific symptoms, thus pose a diagnostic challenge for an emergency care physician. CONCLUSION The report of this case highlights the notion that such rare causes of acute onset dyspnea and upper abdominal pain pose a diagnostic challenge for novice emergency care physicians especially in situations where he/she does not ask for second-line help in general and recommend and rely on a non-specific investigation in specific.
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Gandhi S, Bhandarwar A, Sadhwani N, Patel C, Wagh A, Arora E. Combined laparoscopic and thoracoscopic approach for tension gastrothorax in a foramen of Bochdalek hernia. Int J Surg Case Rep 2019; 65:141-147. [PMID: 31707302 PMCID: PMC6849156 DOI: 10.1016/j.ijscr.2019.10.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The incidence of Bochdalek hernias in adults is much more than previously reported. Though most of these are asymptomatic. Tension gastrothorax is a rare complication of these. Literature about the endoscopic management of a tension gastrothorax is extremely sparse. In this case report, we describe how we combined laparoscopy and thoracoscopy in an emergency setting to manage a case of tension gastrothorax with an underlying Bochdalek hernia defect in an adult. PATIENT PROFILE A 27 year old male presented to our emergency with tension gastrothorax and a gastric volvulus with an underlying Bochdalek hernia defect, exhibiting the classical Borchardt's triad. The patient underwent an emergency surgery, through a minimally invasive approach wherein the herniated contents were reduced, the gastric volvulus detorted and a repair of the diaphragmatic defect was performed. His post-operative course was uneventful. DISCUSSION Tension gastrothorax, is a diagnostic challenge as an air-fluid level in the thorax on radiology with worsening respiration causes as many as 38% of these cases to be misdiagnosed as tension pneumothorax, hydro-pneumothorax, hemothorax, empyema, effusion or pneumonia. Various techniques of decompression have been described in literature but, employing those, in case of a misdiagnosis may have catastrophic outcomes. CONCLUSION We strongly recommend employing a combined laparoscopic and thoracoscopic approach for an emergency repair of a tension gastrothorax in a hemodynamically stable patient as, it poses all the advantages of minimal access surgery and is available, at smaller centres, even in an emergency.
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Affiliation(s)
- Saurabh Gandhi
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Ajay Bhandarwar
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Nidhisha Sadhwani
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India.
| | - Chintan Patel
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Amol Wagh
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Eham Arora
- Department of General Surgery, Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
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Toda M, Yamamoto A, Iwata T. Right-sided Bochdalek hernia containing retroperitoneal fat in the elderly: report of a case. Surg Case Rep 2019; 5:81. [PMID: 31102040 PMCID: PMC6525220 DOI: 10.1186/s40792-019-0637-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/01/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most cases of Bochdalek hernias are diagnosed during the neonatal period and arise on the left side. We report a rare case of a right-sided Bochdalek hernia in an elderly patient. CASE PRESENTATION A 72-year-old man presented with chest tightness and nausea. He had no history of thoracic and abdominal trauma. Preoperative CT scan showed a well-circumscribed mass in the right thoracic cavity of 28-cm diameter compressing the right lower lobe. The mass was mostly fat component and seemed to connect with retroperitoneal fat. We made some diagnoses: lipoma, liposarcoma, and diaphragmatic hernia. Surgical resection was performed by thoracotomy so as to resect the mass and repair the defect of the diaphragm. The mass seemed to be retroperitoneal fat which escaped from the hernia orifice. The neck of the mass was separated by a vessel-sealing device immediately above the hernia orifice. The defect of the diaphragm was repaired by direct suturing after completion of resection. Microscopic pathologic examination showed that the mass was maturated fat tissue. Four months postoperatively, there was no evidence of recurrence of the hernia. CONCLUSIONS The diagnosis of an adult Bochdalek hernia is often difficult, so it is important to consider the examination carefully and to determine the better surgical procedure.
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Affiliation(s)
- Michihito Toda
- Departments of General Thoracic Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, Inabaso 3-1-69, Amagasaki, Hyogo, 660-8511, Japan.
| | - Aya Yamamoto
- Departments of General Thoracic Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, Inabaso 3-1-69, Amagasaki, Hyogo, 660-8511, Japan
| | - Takashi Iwata
- Departments of General Thoracic Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, Inabaso 3-1-69, Amagasaki, Hyogo, 660-8511, Japan
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Murchite SA, Chavannavar KM, Gaikwad VV, Chougale AD, Gandhi S, Singh RK. Bochdalek's hernia in an elderly male - A case report. J Minim Access Surg 2019; 16:182-184. [PMID: 31031318 PMCID: PMC7176018 DOI: 10.4103/jmas.jmas_323_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diaphragmatic hernia is protrusion of the abdominal contents into the thoracic cavity. It is a congenital defect of the diaphragm. It is most commonly encountered in infancy but rarely in adults. Here, we would like to present a rare case of 75-year-old male with Bochdalek's hernia. The patient had presented for the first time in his life for his symptoms. This case report emphasises the rare presentation of Bochdalek's hernia in an elderly male. The patient was treated using minimal access surgery i.e., laparoscopic approach and hence had a better post-operative outcome.
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Affiliation(s)
| | | | | | - Abhay D Chougale
- Department of General Surgery, Dr D Y Patil Hospital, Kolhapur, Maharashtra, India
| | - Saurabh Gandhi
- Department of General Surgery, Dr D Y Patil Hospital, Kolhapur, Maharashtra, India
| | - Rajat Kumar Singh
- Department of General Surgery, Dr D Y Patil Hospital, Kolhapur, Maharashtra, India
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20
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Ménassa M, Bergeron AM, Drolet S, Bouchard A. Strangulated Congenital Diaphragmatic Hernia of Bochdalek Diagnosed in Late Pregnancy: A Case Report and Review of the Literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1482-1484. [PMID: 30799220 DOI: 10.1016/j.jogc.2018.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Congenital diaphragmatic hernia is an unusual condition in the adult population because it is mostly a neonatal diagnosis. This entity may be triggered by pregnancy and threaten the life of the mother and her fetus. CASE This report presents the case of a maternal diaphragmatic hernia diagnosed at 35 weeks of pregnancy with epigastric pain, nausea, and vomiting. Patient developed respiratory distress, and a radiograph revealed left lung collapse. A chest tube was inserted for a presumed tension pneumothorax. The patient's condition deteriorated, and a diaphragmatic hernia containing the stomach, transverse colon, and small bowel was diagnosed. The patient underwent laparotomy with Caesarean section, hernia reduction, and diaphragmatic repair. CONCLUSION A high degree of suspicion is required to avoid misdiagnosis and management delay. Surgical treatment must be individualized according to gestational age and clinical setting.
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Affiliation(s)
- Michel Ménassa
- Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, QC
| | - Anne-Marie Bergeron
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Québec, Québec, QC
| | - Sébastien Drolet
- Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, QC
| | - Alexandre Bouchard
- Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, QC.
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21
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Abstract
AIM To clarify the indications for reconstructive surgery in patients with diaphragmatic hernia. MATERIAL AND METHODS Retrospective trial has included 36 patients with diaphragmatic hernia for the period 1963-2017. There were 23 (63.9%) women and 13 (36.1%) men. The majority of patients (83%) underwent surgery at able-bodied age (18-60 years). 27 (75%) patients had hernia of weak diaphragmatic zones, 9 (25%) - posttraumatic hernia. Diaphragm repair was performed with primary suture. In 2 cases of posttraumatic hernia mesh endoprosthesis was used. RESULTS All patients were discharged. Postoperative complications arose in 4 (11.1%) patients, including 2 cases of mesh endoprosthesis deployment. Long-term outcome was followed-up in 15 patients from 6 months to 17 years. Recurrent hernia was absent in all cases. CONCLUSION Primary suture is acceptable for diaphragmatic hernia repair. Alloplastic repair is indicated for large defect, when primary suture is impossible or risk of its failure is high.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Khetagurov
- Sechenov First Moscow State Medical University, Moscow, Russia
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22
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Souza Neto JRNDE, Branco É, Giese EG, Lima ARDE. Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus). AN ACAD BRAS CIENC 2018; 90:169-178. [PMID: 29466481 DOI: 10.1590/0001-3765201820170167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022] Open
Abstract
The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.
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Affiliation(s)
- José Ricardo N DE Souza Neto
- Laboratório de Pesquisa Morfológica Animal/LaPMA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Érika Branco
- Laboratório de Pesquisa Morfológica Animal/LaPMA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Elane G Giese
- Laboratório de Histologia e Embriologia Animal/LHEA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Ana Rita DE Lima
- Laboratório de Histologia e Embriologia Animal/LHEA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
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Arya S, Shahab S, Kumar R, Garg PK. Adult Bochdalek Hernia with Organo-Axial Gastric Volvulus: Misdiagnosed as Hydropneumothorax. ACTA MEDICA (HRADEC KRALOVE) 2018; 61:108-110. [PMID: 30543516 DOI: 10.14712/18059694.2018.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Bochdalek hernia (BH) in an adult may manifest clinically with a myriad of abdominal or chest symptoms or a combination of them. Diagnosis of an adult BH is usually delayed in view of rarity of the lesion and its varied presentation. A 30-year-old adult gentleman presented to us with a left thoracostomy which was draining pus and ingested food particles. The tube thoracostomy had been performed in another hospital for an apparent left hydropneumothorax before he arrived in our hospital. Computed tomography of Chest and abdomen revealed a left diaphragmatic defect with herniation of stomach, spleen and omentum into the chest with organo-axial volvulus of the stomach. A thoracostomy tube was seen to be traversing through the stomach with its tip located close to the left pulmonary artery. The patient underwent left thoraco-abdominal exploration with dissection and reposition of the hernial contents in the abdominal cavity. The gastric perforations and the diaphragmatic defect were repaired. This case reiterates a well-known fact that an adult type BH must find a place in the differential diagnosis of a hydropneumothorax. Though the adult BH is a rare diagnosis, unawareness or reluctance to consider the possibility of adult BH may prolong the suffering of the patient as it happened in our patient who had iatrogenic perforation of the stomach due to tube thoracostomy.
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Affiliation(s)
- Sugandha Arya
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Saqib Shahab
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Rahul Kumar
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India.
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Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg 2017; 12:23. [PMID: 28529538 PMCID: PMC5437542 DOI: 10.1186/s13017-017-0134-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Antonia Girardi
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Roberta Maria Isernia
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Angela De Palma
- Department of Thoracic Surgery, University of Bari, Bari, Italy
| | - Giovanni Catalano
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Angela Pezzolla
- Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Medical School “A. Moro” of Bari, Bari, Italy
| | - Angela Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
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Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults. Minim Invasive Surg 2016; 2016:9032380. [PMID: 28074156 PMCID: PMC5198190 DOI: 10.1155/2016/9032380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n = 13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands.
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Kohli N, Mitreski G, Yap CH, Leong M. Massive symptomatic right-sided Bochdalek hernia in an adult man. BMJ Case Rep 2016; 2016:bcr-2016-217432. [PMID: 27852660 DOI: 10.1136/bcr-2016-217432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.
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Affiliation(s)
- Naman Kohli
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Goran Mitreski
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Matthew Leong
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
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Moser F, Signorini FJ, Maldonado PS, Gorodner V, Sivilat AL, Obeide LR. Laparoscopic Repair of Giant Bochdalek Hernia in Adults. J Laparoendosc Adv Surg Tech A 2016; 26:911-915. [PMID: 27603937 DOI: 10.1089/lap.2016.0402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Bochdalek hernia is a congenital diaphragmatic defect that results from improper fusion of the septum transversum and the pleuroperitoneal folds. It rarely persists asymptomatic until adulthood. The reported incidence is as low as 0.17%. Surgical repair of the defect can be performed through the abdomen or through the chest, and in both cases open or through laparoscopy/thoracoscopy. CASE REPORT We present 2 cases of fully laparoscopic repair of giant Bochdalek hernia in adults. In both cases we used a GORE® DUALMESH® and we had neither complications nor recurrence. It is worthy of mention that hernia sac was not found in any of the cases. This has been described as a distinct characteristic that confirms diagnosis. CONCLUSION Bochdalek hernia in the adult is a rare entity that requires surgical treatment to avoid complications. CT scan of the abdomen and chest with oral and IV contrast is the gold standard for diagnosis.
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Affiliation(s)
- Federico Moser
- 1 Hospital Privado Universitario de Córdoba , Córdoba, Argentina
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28
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Machado NO. Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:65-74. [PMID: 27042603 PMCID: PMC4791901 DOI: 10.4103/1947-2714.177292] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
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29
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Kim YS, Lee IS, Jung GU, Kim MJ, Oh CS, Yoo DS, Lee WJ, Lee E, Cha SC, Shin DH. Radiological diagnosis of congenital diaphragmatic hernia in 17th century Korean mummy. PLoS One 2014; 9:e99779. [PMID: 24988465 PMCID: PMC4079512 DOI: 10.1371/journal.pone.0099779] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/19/2014] [Indexed: 12/23/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm resulting in pulmonary sequelae that threaten the lives of infants. In computed tomography (CT) images of a 17th century middle-aged male mummy (the Andong mummy), we observed that the abdominal contents had protruded into the right thoracic cavity through the diaphragmatic defect, accompanied by a mediastinal shift to the left. On autopsy, the defect in the right posterolateral aspect of the diaphragm was reconfirmed, as was the herniation of the abdominal organs. The herniated contents included the right lobe of the liver, the pyloric part of the stomach, a part of the greater omentum, and the right colic flexure connecting the superior part of the ascending colon and the right part of the transverse colon. Taking our CT and autopsy results together, this case was diagnosed as the Bochdalek-type CDH. Herein we make the first ever report of a CT-assisted diagnosis of a pre-modern historical case of CDH. Our results show the promising utility of this modality in investigations of mummified human remains archaeologically obtained.
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Affiliation(s)
- Yi-Suk Kim
- Department of Anatomy, Ewha Womans University School of Medicine, Seoul, Korea
| | - In Sun Lee
- Department of Radiology, Seoul National University Hospital, Bundang, Korea
| | - Go-Un Jung
- Department of Anatomy, Ewha Womans University School of Medicine, Seoul, Korea
| | - Myeung Ju Kim
- Department of Anatomy, Dankook University College of Medicine, Chonan, Korea
| | - Chang Seok Oh
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
- Institute of Forensic Science, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Su Yoo
- Department of Diagnostic Radiology, Dankook University College of Medicine, Chonan, Korea
| | - Won-Joon Lee
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
- Institute of Forensic Science, Seoul National University College of Medicine, Seoul, Korea
| | - Eunju Lee
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Soon Chul Cha
- Dongguk Institute of Cultural Properties, Daegu, Korea
| | - Dong Hoon Shin
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
- Institute of Forensic Science, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Repair of Bochdalek hernia in an adult complicated by abdominal compartment syndrome, gastropleural fistula and pleural empyema: Report of a case. Int J Surg Case Rep 2013; 5:82-5. [PMID: 24441713 PMCID: PMC3921646 DOI: 10.1016/j.ijscr.2013.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Bochdalek's diaphragmatic hernia (BDH) rarely developed symptomatic in adulthood but mostly required an operation. In adult BDH cases, long-term residing of the massive intraabdominal organs in the thoracic cavity passively causes loss of domain for abdominal organs (LOD). PRESENTATION OF CASE A 63-year-old man presented at our institution complaining of sudden left upper quadrant abdominal pain. Chest radiography showed a hyperdense lesion containing bowel gas in the left pleural space. Computed tomography revealed a dilated bowel above the diaphragm and intestinal obstruction suggestive of gangrenous changes. These findings were consistent with the diagnosis of incarcerated BDH and an emergency laparotomy was performed. Operative findings revealed the hypoplastic lung, lack of hernia sac, and location of the diaphragmatic defect, which indicated that his hernia was true congenital. Organs were reduced into the abdominal cavity, and large defect of the diaphragm was repaired with combination of direct vascular closure and intraperitoneal onlay mesh reinforcement using with expanded polytetrafluoroethylene (ePTFE) mesh. On the postoperative day 1, the patient fell into the shock and was diagnosed to have abdominal compartment syndrome (ACS). Conservative therapies were administered, but resulted in gastropleural fistula and pleural empyema, which required an emergency surgery. Mesh extraction and fistulectomy were performed. DISCUSSION A PubMed search for the case of ACS after repair of the adult BDH revealed only three cases, making this very rare condition. CONCLUSION In dealing with adult BDH, possible post-repair ACS should be considered.
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Late-onset congenital diaphragmatic hernia: A case report. Int J Surg Case Rep 2013; 4:952-4. [PMID: 24055915 PMCID: PMC3825969 DOI: 10.1016/j.ijscr.2013.07.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/29/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiafragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. PRESENTATION OF CASE In this paper we present a 35 year old man with a 5-year history of episodes of severe dyspnea who arrived to the emergency room, during his medical work-up we incidentally found an intrathoracic gastric bubble, a laparoscopy was performed, founding a necrotic stomach and for defect correction. DISCUSSION This pathology is infrequent in adults, among this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. CONCLUSION Diaphragmatic hernias are rare among adult population, and they are usually asymptomatic, in this case we presented a symptomatic patient, diagnosed with a chest X-ray and treated surgically. The surgical approach for the resolution of this pathology is variable and it depends on the presence and severity of visceral complications.
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Choi YK, Ahn JH, Kim KC, Won TH. An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:348-50. [PMID: 23130314 PMCID: PMC3487024 DOI: 10.5090/kjtcs.2012.45.5.348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/21/2012] [Accepted: 06/04/2012] [Indexed: 11/16/2022]
Abstract
We herein report a very rare case of adult right-sided Bochdalek hernia accompanied with hepatic hypoplasia and inguinal hernia. A 29-year-old man was admitted with right-sided pneumothorax. A computed tomography was performed and revealed large right sided Bochdalek hernia with hepatic hypoplasia. Under thoracolaparotomy, the defect was closed with Gore-Tex soft tissue patch. After the operation, left-sided inguinal hernia was found. However, it turned out that it had been present during infancy and spontaneously resolved during adolescence. This is the first report of right-sided Bochdalek hernia with hepatic hypoplasia and inguinal hernia in an adult.
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Affiliation(s)
- Yun Kyung Choi
- Department of Thoracic and Cardiovascular Surgery, Ewha Womans University School of Medicine, Korea
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John PH, Thanakumar J, Krishnan A. Reduced port laparoscopic repair of Bochdalek hernia in an adult: A first report. J Minim Access Surg 2012; 8:158-160. [PMID: 23248447 PMCID: PMC3523457 DOI: 10.4103/0972-9941.103131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 10/15/2012] [Indexed: 11/08/2022] Open
Abstract
Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic hernia repaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.
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Affiliation(s)
- Pravin Hector John
- Minimal Access, Bariatric and GI Surgery, Global Hospitals and Health City, Chennai, India
| | - John Thanakumar
- Minimal Access, Bariatric and GI Surgery, Global Hospitals and Health City, Chennai, India
| | - Arunkumar Krishnan
- Minimal Access, Bariatric and GI Surgery, Global Hospitals and Health City, Chennai, India
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Ayiomamitis GD, Stathakis PC, Kouroumpas E, Avraamidou A, Georgiades P. Laparoscopic repair of congenital diaphragmatic hernia complicated with sliding hiatal hernia with reflux in adult. Int J Surg Case Rep 2012; 3:597-600. [PMID: 22986157 DOI: 10.1016/j.ijscr.2012.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) in adults is a relatively rare condition being asymptomatic in the majority of cases. Symptomatic CDH should prompt surgical management because they may lead to intestinal obstruction or severe pulmonary disease. This is the first reported case of a symptomatic CDH complicated with sliding hiatal hernia (SHH). PRESENTATION OF CASE A 65 years old women with reflux and dysphagia was complaining of postprandial paroxysmal dyspnea and epigastric pain radiating to her back. Upper endoscopy diagnosed sliding and para-esophageal diaphragmatic hernia with severe esophagitis. Computed tomography-scan revealed a large Bochdalek hernia at the left diaphragm. DISCUSSION Diagnostic laparoscopy was decided, which confirmed the SHH, but also revealed a CDH defect at the tendonous part of the left diaphragm. The left bundle of the right crus was intact, separating the two hernia components (sliding and congenital). Extensive adhesiolysis was performed, dissecting and separating the stomach away from the diaphragm. Posterior cruroplasty at the esophageal hiatus was performed for the SHH with Nissen fundoplication as antireflux procedure. Primary continuous suture repair was performed for the CDH, reinforced with prosthetic mesh on top. Operative time was 150min with no morbidity. The patient was discharged home uneventfully the third postoperative day. On 12-months follow-up, she reported no symptoms and improvement in quality of life. CONCLUSION Laparoscopy is a unique method for a precise diagnosis of symptomatic congenital diaphragmatic hernia in adults being also a safe and viable technique for a successful repair at the same time. Experience of advanced laparoscopic surgery is required.
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Affiliation(s)
- Georgios D Ayiomamitis
- 2nd Surgical Department, Tzaneion General Hospital of Piraeus, Greece; Chicago Institute of Minimally Invasive Surgery, Skokie, IL, USA.
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Shakir NF, Alsaad W, Mahi S. Bochdalek hernia of adult in emergency situation. JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2012. [DOI: 10.5339/jemtac.2012.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Warda Alsaad
- Emergency Department, Hamad General
Hospital, Doha, Qatar
| | - Saad Mahi
- Emergency Department, Hamad General
Hospital, Doha, Qatar
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Toydemir T, Akinci H, Tekinel M, Süleyman E, Acunaş B, Yerdel MA. Laparoscopic repair of an incarcerated bochdalek hernia in an elderly man. Clinics (Sao Paulo) 2012; 67:199-201. [PMID: 22358250 PMCID: PMC3275124 DOI: 10.6061/clinics/2012(02)20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Toygar Toydemir
- General Surgery Department, Istanbul Surgery Hospital, Istanbul, Turkey.
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Alam A, Chander BN. Adult Bochdalek Hernia. Med J Armed Forces India 2011; 61:284-6. [PMID: 27407781 DOI: 10.1016/s0377-1237(05)80177-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Accepted: 10/09/2004] [Indexed: 10/18/2022] Open
Affiliation(s)
- A Alam
- Associate Professor, Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune-40
| | - B N Chander
- Senior Advisor, Department of Radiodiagnosis and Imaging, Command Hospital (Air Force) Bangalore
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Sofi FA, Ahmed SH, Dar MA, Nabhi DG, Mufti S, Bhat MA, Tabassum PN. Nontraumatic massive right-sided Bochdalek hernia in an adult:. Am J Emerg Med 2011; 29:356.e5-7. [DOI: 10.1016/j.ajem.2010.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/31/2010] [Indexed: 11/28/2022] Open
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Intrathoracic caecal perforation presenting as dyspnea. Case Rep Med 2011; 2010:296730. [PMID: 21331329 PMCID: PMC3038627 DOI: 10.1155/2010/296730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 11/29/2010] [Accepted: 12/21/2010] [Indexed: 11/17/2022] Open
Abstract
Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult.
Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.
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Mathai AS, Singh M. Peri-operative course of peritonitis following tube thoracostomy: A misdiagnosed case of congenital diaphragmatic hernia. Anesth Essays Res 2011; 5:92-4. [PMID: 25885308 PMCID: PMC4173365 DOI: 10.4103/0259-1162.84181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A young adult presented with signs of peritonitis following tube thoracostomy for suspected acute hydropneumothorax. Attempted decompression of the chest by tube thoracostomy had caused gastric perforation, and on surgical exploration, he was found to have a congenital diaphragmatic hernia with herniation of the stomach, spleen and colon. All intensive care doctors and emergency room physicians dealing with the care of patients with acute respiratory failure should be taught to recognize and keep the possibility of a Bochdalek hernia in mind, especially in young adults presenting with unusual respiratory and gastrointestinal symptoms.
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Affiliation(s)
- Ashu S Mathai
- Department of Anesthesiology, Christian Medical College, Ludhiana, Punjab, India
| | - Madhurita Singh
- Department of Anesthesiology, Padhar Hospital, Madhya Pradesh, India
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Diaz-Nieto R, Naranjo-Torres A. Bochdalek hernia (Acute gastric obstruction and laparoscopic approach). Health (London) 2011. [DOI: 10.4236/health.2011.310102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Bochdalek hernias (BHs) arise due to congenital diaphragmatic defect and can result in gross displacement of abdominal tissues into the thorax. Although they are uncommon in occurrence, they usually present as serious respiratory distress in infants. In the adult population, they are asymptomatic and only detected incidentally. In this report, we present the case of a 26-year-old male who acutely presented with severe epigastric pain radiating to the back and deranged vital signs as a result of incorrect previous diagnoses. A large left diaphragmatic hernia containing his pancreatic tail, spleen, stomach and other intra-abdominal organs was confirmed by CT scan, together occupying a third of the hemithorax. Although not common, diagnostics of BHs should be considered in patients presenting with acute abdomen. A plain chest X-ray displaying diminished left diaphragmatic outline or signs of mediastinal shift should raise suspicion. Previous normal chest X-ray can be deceptive and does not rule out a diaphragmatic hernia. Herein, we also review the literature for previously reported acute presentation of 11 similar cases in adults and highlight the value of including BH as one of the differential diagnoses.
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Affiliation(s)
- Erdinc Soylu
- Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK
| | - Sameer Junnarkar
- Department of Surgery, Barts and the London NHS Trust, The Royal London Hospital, London, UK
| | - Hemant M. Kocher
- Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK
- Department of Surgery, Barts and the London NHS Trust, The Royal London Hospital, London, UK
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Abstract
Rare congenital diaphragmatic defects resulting from failure of posterolateral diaphragmatic foramina to fuse may be approached laparoscopically and repaired successfully. Background and Objectives: Bochdalek hernias are congenital diaphragmatic defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. We describe our experience with this rare entity. Methods: A retrospective chart review was performed on a single patient for data collection purposes. Results: The patient is a morbidly obese 53-year-old female who presented with epigastric pain and diffuse abdominal tenderness. Computed tomography scans of the chest and abdomen revealed a small posterior diaphragmatic defect containing gastric fundal diverticulum. Laboratory work and imaging revealed no other findings. Laparoscopic repair of the Bochdalek hernia was done via an abdominal approach and utilized primary closure with an AlloDerm patch apposed to the defect. The patient has had significant clinical improvement and continues to do well at 9 months postoperatively. Conclusion: Laparoscopic repair of symptomatic adult Bochdalek hernias can be performed successfully and may result in significant clinical improvement.
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Affiliation(s)
- Kamran S Hamid
- Department of Surgery, Scott and White Memorial Hospital, Scott, Sherwood and Brindley Foundation, The Texas A&M University Health Science Center, 2401 South 31st Street, Temple, Texas 76508, USA.
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Laparoscopic dual mesh repair of a diaphragmatic hernia of Bochdalek in a symptomatic elderly patient. Updates Surg 2010; 62:125-8. [PMID: 20859719 DOI: 10.1007/s13304-010-0022-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
Bochdalek hernia is a congenital posterolateral diaphragmatic defect. It is usually diagnosed in newborns and children; the mortality rate is high due to further congenital anomalies such as pulmonary hypoplasia and pulmonary hypertension. In adulthood, the diagnosis is often incidental, while sometimes it is related to gastrointestinal or respiratory symptoms, or to herniated viscera complications. Thus, surgical treatment is advocated. We herein report a case of an 86-year-old woman with dyspnea and dysphagia. After the diagnosis by barium enema and CT scan of the herniated stomach and the greater omentum through a left side foramen of Bochdalek, she underwent a successful laparoscopic dual mesh repair and was discharged on the 6th postoperative day.
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Brown SR, Horton JD, Trivette E, Hofmann LJ, Johnson JM. Bochdalek hernia in the adult: demographics, presentation, and surgical management. Hernia 2010; 15:23-30. [PMID: 20614149 DOI: 10.1007/s10029-010-0699-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 06/12/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bochdalek hernias are a very rare form of diaphragmatic hernias. There are no robust studies that reveal the true natural history of this disease process. The aim of this study was to summarize clinically relevant data for the purpose of assisting surgeons with the work-up, diagnosis, and treatment of adult patients with Bochdalek hernia. METHODS A literature search was performed using PubMed, Google scholar, EMBASE and the following keywords: Bochdalek hernia, congenital diaphragmatic hernia, and posterolateral hernia. All case reports and series after 1955 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies utilized during work-up, laterality, surgical approach, hernia sac management, specific minimally invasive surgical techniques, and follow-up. RESULTS A total of 124 articles comprising 173 patients met the inclusion criteria. Based on the data provided, several conclusions regarding this disease process can be made. Most patients present with symptoms related to their hernia (86%). Pain is the most common complaint (69%). While laparotomy is the most widely used surgical approach (38%), minimally invasive surgical techniques have gained popularity since their first report in 1995. Laparoscopic repair can be performed with a low complication rate (7%) and short hospital stay (4 days). CONCLUSIONS Using modern surgical techniques to include laparoscopy, repair can be performed safely, with a short hospital stay, and with minimal morbidity or mortality.
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Affiliation(s)
- S R Brown
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras St, El Paso, TX 79920, USA.
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Trivedi PJ, Canavan J, Holloway C, Slater A, Travis S. An unusual case of dyspnoea in an elderly man. BMJ Case Rep 2010; 2010:bcr09.2009.2247. [PMID: 22242046 DOI: 10.1136/bcr.09.2009.2247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature. Most adolescent and adult cases are diagnosed incidentally during imaging for upper gastrointestinal symptoms. It is unusual for adults to present with respiratory symptoms. We describe the case of a 71-year-old man who presented with features of left ventricular failure due to an exceptionally large, right sided Bochdalek hernia. This is the oldest clinical presentation of a right sided Bochdalek hernia, which uniquely included trans-diaphragmatic herniation of the pancreas.
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Abstract
Bochdalek hernias are rare in adults. We report 2 cases of Bochdalek hernia with bowel obstruction. The first case was a 74-year-old male patient who suffered from abdominal pain and chest tightness for 1 day. Chest radiography indicated a mass-like lesion above the left diaphragm. The pain could not be relieved by nasogastric tube decompression for 12 hours. We arranged computed tomography, which revealed a dilated bowel above the diaphragm and intestinal obstruction with gangrenous change. The patient received emergency laparotomy, and a Bochdalek hernia was detected during the operation. The second case was a 75-year-old female patient who suffered from chest tightness and dyspnea for about 1 week. Chest X-ray and magnetic resonance imaging revealed herniation of small and large bowels at the right posterior aspect of the thoracic cavity. She received transthoracic repair of diaphragmatic hernia, recovered, and was discharged 15 days later. We recommend that adult Bochdalek hernia should be considered in the differential diagnosis of bowel obstruction.
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Affiliation(s)
- Yeh-Huang Hung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Bing Show Chwan Hospital, Chunghua, Taiwan, ROC
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Mishra PK, Shackcloth M, Andrew E, Page RD. Late presentation of congenital Bochdalek hernia: a case report. Asian Cardiovasc Thorac Ann 2008; 14:525-7. [PMID: 17130334 DOI: 10.1177/021849230601400619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 23-year-old man presented with a long history of dyspnea and wheezing thought to be due to asthma. Abnormal appearance of the left hemithorax was an incidental finding on a chest X-Ray. On further investigations he was found to have congenital Bochdalek hernia which was repaired surgically. All his respiratory symptoms resolved and he was able to discontinue treatment for asthma. We want to emphasise that late presentations can be misleading even to an astute clinician.
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Affiliation(s)
- Pankaj K Mishra
- Department of Cardiothoracic Surgery, Liverpool Cardiothoracic Center, Liverpool, United Kingdom.
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Megremis SD, Segkos NI, Gavridakis GP, Mattheakis MG, Kehayas EG, Triantafyllou LB, Sfakianaki EE, Chalkiadakis GE. Sonographic appearance of a late-diagnosed left bochdalek hernia in a middle-aged woman: case report and review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:412-7. [PMID: 16240423 DOI: 10.1002/jcu.20158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A 53-year-old woman complaining of left upper lateral quadrant pain was first referred for an abdominal ultrasound. The spleen was disfigured, the suprasplenic echogenic line of the hemidiaphragm was fragmented, and part of bowel was inserted into the thorax. A diaphragmatic hernia was suggested and was further confirmed in a posterolateral position.
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Abstract
Incidental adult Bochdalek hernia is a posterolateral diaphragmatic opening with transit of intra-abdominal contents into the thorax, having been diagnosed while being imaged for another reason. Size and contents are variable. Epidemiological factors and prevalence are controversial. Patients may suffer morbidity and mortality depending on involvement of organs. Diagnosis is made predominantly by routine computed tomographic scan, which is improved by the use of three-dimensional techniques and now-routine multi-detector row technology.
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Affiliation(s)
- Mark E Mullins
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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