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Bridges CJ, Hasson RM. Congenital Hernias in Adults: Bochdalek Hernias. Thorac Surg Clin 2024; 34:155-162. [PMID: 38705663 DOI: 10.1016/j.thorsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Bochdalek hernias are a rare occurrence in adults and usually asymptomatic, resulting in incidental discovery. However, surgical intervention is recommended for both symptomatic and asymptomatic Bochdalek hernias due to the risk of acute morbidity and mortality. There are various possible surgical approaches that may be appropriate depending on the circumstance, with robotic repair becoming increasingly popular. To date, the rarity of the condition has limited the available data on postoperative outcomes.
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Affiliation(s)
- Connor J Bridges
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Rian M Hasson
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; The Dartmouth Institute of Health Policy and Clinical Practice, Williamson Translational Research Building, Level 51 Medical Center Drive, Lebanon, NH 03756, USA.
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2
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Martusciello GR, Sullivan GA, Koo N, Pillai S, Madonna MB, Shah AN, Gulack BC. Reduced Long-Term Bowel Obstruction Risk With Minimally Invasive Diaphragmatic Hernia Repair. J Surg Res 2024; 294:144-149. [PMID: 37890273 DOI: 10.1016/j.jss.2023.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The introduction of minimally invasive surgery (MIS) for repair of congenital diaphragmatic hernias (CDH) has reduced postoperative length of stay, postoperative opioid consumption, and provided a more esthetic repair. In adult abdominal surgery, minimally invasive techniques have been associated with decreased long-term rates of small bowel obstruction (SBO), although it is unclear if this benefit carries over into the pediatric population. Our objective was to evaluate the rates of SBO following open versus MIS CDH repair. MATERIAL AND METHODS Infants who underwent CDH repair between 2010 and 2021 were identified using the PearlDiver Mariner database. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate time to SBO by surgical approach (MIS versus open) while adjusting for mesh use, patient sex, and length of stay. RESULTS Of 1033 patients that underwent CDH repair, 258 (25.0%) underwent a minimally invasive approach. The overall rate of SBO was 7.5% (n = 77). Rate of SBO following MIS repair was lower than open repair at 1 y (0.8% versus 5.1%), 3 y, (2.3% versus 9.0%), and 5 y (4.4% versus 10.1%, P = 0.004). Following adjustment, the rate of SBO following MIS repair remained significantly lower than open repair (adjusted hazard ratio: 0.37, 95% confidence interval: 0.18, 0.79). CONCLUSIONS Following CDH repair, long-term rates of SBO are lower among patients treated with MIS approaches. Long-term risk of SBO should be considered when selecting surgical approach for CDH patients.
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Affiliation(s)
- Gerard R Martusciello
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nathaniel Koo
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Srikumar Pillai
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
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3
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Lee SH. Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature [Response to Letter]. Int J Womens Health 2024; 16:175-178. [PMID: 38313598 PMCID: PMC10838507 DOI: 10.2147/ijwh.s456514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Affiliation(s)
- Sang Hun Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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Predescu D, Achim F, Socea B, Ceaușu MC, Constantin A. Rare Diaphragmatic Hernias in Adults-Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature. Diagnostics (Basel) 2023; 14:85. [PMID: 38201394 PMCID: PMC10795705 DOI: 10.3390/diagnostics14010085] [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: 11/02/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias-Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1-7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm2 (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%.
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Affiliation(s)
- Dragos Predescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Florin Achim
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Surgery, “Sf. Pantelimon” Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Mihail Constantin Ceaușu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Histopathology, Alexandru Trestioreanu” National Institute of Oncology, 022328 Bucharest, Romania
| | - Adrian Constantin
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
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5
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Augustin G. Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature [Letter]. Int J Womens Health 2023; 15:1961-1962. [PMID: 38144946 PMCID: PMC10748712 DOI: 10.2147/ijwh.s451513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine University of Zagreb, Zagreb, Croatia
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Chae AY, Park SY, Bae JH, Jeong SY, Kim JS, Lee JS, Kim SJ, Lee SJ, Lee SH. Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature. Int J Womens Health 2023; 15:1757-1769. [PMID: 38020943 PMCID: PMC10657747 DOI: 10.2147/ijwh.s432463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Bochdalek hernia (BH) of congenital diaphragm hernia is infrequently seen in adults. Strangulation of the diaphragm hernia has been recognized as a severe complication. Among several factors, pregnancy is an important cause of diaphragm hernia's deterioration. However, nausea, vomiting, and upper abdominal pain are often considered non-specific pregnancy-related symptoms. Case Presentation We report a case of a 39-year-old (gravida II, para I) multigravida woman with a delayed diagnosis of strangulated herniated viscera complicating total gastric gangrene at 26+1 weeks' gestation. The preoperative diagnosis was confirmed by an X-ray examination and magnetic resonance imaging (MRI). After identifying the size and severity of the herniated contents through video-assisted thoracoscopy (VAT), we immediately converted to abdominal laparotomy. Antenatal corticosteroids were administered simultaneously with diagnosis to promote fetal maturity. The fetal condition was maintained well in the maternal uterus during the operation. Careful monitoring of the fetus and the mother's clinical conditions should be performed during expectant management to achieve delayed delivery after maternal surgical correction. Delivery was completed through cesarean delivery at 27+1 weeks of gestation. Conclusion Despite the rarity of maternal Bochdalek hernias during pregnancy, early diagnosis and appropriate treatment via multidisciplinary care are essential for maternal and fetal outcomes.
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Affiliation(s)
- Ah Yeong Chae
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Yeon Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hyun Bae
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Yeon Jeong
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Su Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Soo Lee
- Department of Obstetrics and Gynecology, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Soo Jin Kim
- Department of Obstetrics and Gynecology, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Soo Jeong Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sang Hun Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
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Salajegheh P, Gilani A, Yazdi F, Sarmadian R, Habibzadeh A. Bochdalek hernia presenting as recurrent fever and bicytopenia in a pediatric patient: A rare case report. Clin Case Rep 2023; 11:e8039. [PMID: 37830069 PMCID: PMC10565089 DOI: 10.1002/ccr3.8039] [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] [Received: 09/16/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Bochdalek hernia is a rare condition characterized by the displacement of abdominal contents into the thoracic cavity. Due to the nonspecific nature of symptoms, prompt diagnosis, and management by emergency care providers can be challenging. Treatment of a Bochdalek hernia typically involves the reduction in the herniated contents back into the abdominal cavity. In this case report, we present the case of a 1-year-old girl who presented to the emergency department with a fever and bicytopenia. Further evaluation revealed a Bochdalek hernia, which was successfully managed with surgical intervention. This case highlights the importance of considering a Bochdalek hernia in the differential diagnosis of patients presenting with recurrent nonspecific symptoms (fever and bicytopenia).
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Affiliation(s)
- Pouria Salajegheh
- Department of Pediatric Hematology & OncologyKerman University of Medical SciencesKermanIran
| | - Abolfazl Gilani
- Sina Trauma & Surgery Research CenterTehran University of Medical SciencesTehranIran
| | - Farzaneh Yazdi
- Endocrinology and Metabolism Research CenterKerman University of Medical SciencesKermanIran
| | - Roham Sarmadian
- Infectious Diseases Research CenterArak University of Medical SciencesArakIran
| | - Adrina Habibzadeh
- Student Research CommitteeFasa University of Medical SciencesFasaIran
- USERN OfficeFasa University of Medical SciencesFasaIran
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Eldaabossi S, Al-Ghoneimy Y, Abish YG, Farouk A, Kanany H, Taha A, Kabil A, Nabawi U, Lofty A, Makled S, Mahdi W, Zagloul B. Late presentation of a congenital problem; complicated left-sided Bochdalek's hernia in an adult: A case report. Respir Med Case Rep 2023; 45:101903. [PMID: 37599895 PMCID: PMC10432773 DOI: 10.1016/j.rmcr.2023.101903] [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: 11/11/2022] [Revised: 03/10/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
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.
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Affiliation(s)
- Safwat Eldaabossi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Yasser Al-Ghoneimy
- Cardiothoracic Surgery Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
| | - Yasser G. Abish
- Radiology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Radiology, Al Azhar Faculty of Medicine, Egypt
| | - Abdallah Farouk
- Critical Care Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Critical Care, Alexandria Faculty of Medicine, Egypt
| | - Hatem Kanany
- Consultant Critical Care and Anesthesia, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Taha
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Kabil
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Usama Nabawi
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Ahmed Lofty
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Sameh Makled
- Department of Chest Diseases, Al Azhar Faculty of Medicine, Egypt
| | - Waheed Mahdi
- Pulmonology Consultant, Almoosa Specialist Hospital, Al Ahsa. Saudi Arabia
- Department of Chest Diseases, Banha Faculty of Medicine, Egypt
| | - Boshra Zagloul
- Department of Radiology, Al Azhar Faculty of Medicine for Girls, Egypt
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9
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Giuffrida M, Perrone G, Abu-Zidan F, Agnoletti V, Ansaloni L, Baiocchi GL, Bendinelli C, Biffl WL, Bonavina L, Bravi F, Carcoforo P, Ceresoli M, Chichom-Mefire A, Coccolini F, Coimbra R, de'Angelis N, de Moya M, De Simone B, Di Saverio S, Fraga GP, Galante J, Ivatury R, Kashuk J, Kelly MD, Kirkpatrick AW, Kluger Y, Koike K, Leppaniemi A, Maier RV, Moore EE, Peitzmann A, Sakakushev B, Sartelli M, Sugrue M, Tian BWCA, Broek RT, Vallicelli C, Wani I, Weber DG, Docimo G, Catena F. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper. World J Emerg Surg 2023; 18:43. [PMID: 37496073 PMCID: PMC10373334 DOI: 10.1186/s13017-023-00510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023] Open
Abstract
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.
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Affiliation(s)
| | - Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, Via A. Gramsci 14, 43126, Parma, Italy.
| | - Fikri Abu-Zidan
- Research Office, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Gian Luca Baiocchi
- General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cino Bendinelli
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Walter L Biffl
- Acute Care Surgery at The Queen's Medical Center, John A. Burns School of Medicine, University of Hawai'I, Honolulu, USA
| | - Luigi Bonavina
- Department of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, , Riverside, California, USA
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Marc de Moya
- Trauma/Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint-Germain-en-Laye Hospitals, Poissy, France
| | - Salomone Di Saverio
- Department of General Surgery, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy
| | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Joseph Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | - Rao Ivatury
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Andrew W Kirkpatrick
- Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Ernest Eugene Moore
- Department of Surgery, Denver Health Medical Center,, University of Colorado, Denver, CO, USA
| | - Andrew Peitzmann
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | | | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Richard Ten Broek
- Surgery Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Imtaz Wani
- Department of Minimal Access and General Surgery, Government Gousia Hospital, Srinagar, India
| | - Dieter G Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Giovanni Docimo
- Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
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10
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Steen C, Lee JH, Wong E, Mackay S. Laparoscopic Repair of Bochdalek Hernia: A Rare Presentation of Abdominal Pain in the Elderly. Case Rep Surg 2023; 2023:5361609. [PMID: 37427295 PMCID: PMC10328725 DOI: 10.1155/2023/5361609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Bochdalek hernias (BHs) are rare, and the presentation, diagnosis, and management of them can be complex. We present a 70-year-old man presenting with left flank pain who underwent a successful laparoscopic repair of BH with mesh placement.
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Affiliation(s)
- Christopher Steen
- Monash University, Melbourne, VIC, Australia
- Department of Surgery, Eastern Health, Box Hill, VIC, Australia
| | - Jia Hui Lee
- Department of Surgery, Eastern Health, Box Hill, VIC, Australia
| | - Enoch Wong
- Department of Surgery, Eastern Health, Box Hill, VIC, Australia
| | - Sean Mackay
- Department of Surgery, Eastern Health, Box Hill, VIC, Australia
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11
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Frey S, Chazal M, Sejor E, Baque P, Mouroux J. Case reports: a variety of clinical presentations and long-term evolution of Bochdalek hernias. Front Surg 2023; 10:1150241. [PMID: 37304187 PMCID: PMC10251140 DOI: 10.3389/fsurg.2023.1150241] [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] [Received: 01/23/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Bochdalek hernias are the most common congenital diaphragmatic hernias, followed by Morgagni hernias. The failure of closure of the pleuroperitoneal membrane results in a posterolateral foramen, which can remain silent until adulthood. They remain a rare pathology with nearly a hundred cases published. Its clinical presentation is variable, making its diagnosis challenging for clinicians. Additionally, its symptoms are not necessarily representative of the content of the hernia. Its management is balanced between the abdominal and the thoracic approaches. However, no guidelines or algorithms are available to help surgeons in the decision-making process. We report here four consecutive cases of symptomatic Bochdalek hernias. Each case has a singular presentation, and we share how they were approached at our institution. In particular, this series shows no reoccurrence in 10+ years of follow-up in two cases and 20+ in one case, underlying the importance of surgical management when Bochdalek hernias are symptomatic.
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Affiliation(s)
- Sebastien Frey
- Department of General Surgical Emergency, Pasteur 2 Hospital, University Hospital of Nice, Nice, France
- Université Côte d’Azur, Nice, France
| | - Maurice Chazal
- Department of General Surgery, Princess Grace Hospital, Monaco, Monaco
| | - Eric Sejor
- Department of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Patrick Baque
- Department of General Surgical Emergency, Pasteur 2 Hospital, University Hospital of Nice, Nice, France
- Université Côte d’Azur, Nice, France
| | - Jerome Mouroux
- Université Côte d’Azur, Nice, France
- Department of Thoracic Surgery, Pasteur 1 Hospital, University Hospital of Nice, Nice, France
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12
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Dahaba AA. Difficult airway management and low Bispectral Index (BIS) in a patient with left Bochdalek congenital diaphragmatic hernia (CDH). BMC Anesthesiol 2023; 23:172. [PMID: 37210500 PMCID: PMC10199628 DOI: 10.1186/s12871-023-02140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Bochdalek congenital diaphragmatic hernia (CDH) is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the developing lung parenchyma and lung hypoplasia. We describe a case of an adult patient with a Bochdalek hernia who underwent minimally invasive right thoracotomy Perceval bioprosthetic aortic valve replacement (AVR) requiring one-lung ventilation (OLV) on the side of the hernia. This is a complex and challenging case that brings up numerous thought-provoking anesthetic implications. To the best of our knowledge, a Pubmed search did not reveal any publication to date of difficult airway management in an adult patient with CDH. CASE PRESENTATION The first major problem encountered was patient's crus habitus anatomical condition (exceedingly ventrally displaced trachea) Mallampati Class IV and Cormack-Lehane grade IV extremely difficult endotracheal intubation. Neither glottis nor epiglottis was visible on laryngoscopy; resulting in failed placement of the double-lumen endobronchial tube (DLT) following numerous attempts. The DLT was eventually placed via GlideScope videolaryngoscopy. Whereas the endobroncheal right lung block for left OLV was successfully placed using fiberopticscopy. The crus habitus encroached on OLV tidal volume by the cranially displaced ascending colon and left kidney. Anesthesia was maintained with remifentanil /sevoflurane; adjusted to maintain bispectral index (BIS) at 40-60. Digitally recorded BIS was 38-62 except when BIS precipitously declined to 14-38 (SR, suppression ratio < 10) for 25 min after termination of the cardiopulmonary bypass. CONCLUSIONS We report a case essentially dealing with an anatomically distorted difficult airway in a patient with left Bochdalek CDH undergoing a complex AVR. We describe anesthetic difficulties and unforeseen issues encountered; such as an extremely difficult DLT placement.
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Affiliation(s)
- Ashraf A Dahaba
- Department of Anaesthesiology and Intensive Care Medicine, Suez Canal University, Ismailia, 41522, Egypt.
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13
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Sanz del Pozo M, García de Jalón Martínez Á, Ordóñez Lozano PA, Sánchez Zalabardo JM. Thoracic kidney nephrectomy due to recurrent Bochdalek hernia in an adult. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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14
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Sanz Del Pozo M, García de Jalón Martínez Á, Ordóñez Lozano PA, Sánchez Zalabardo JM. Thoracic kidney nephrectomy due to recurrent Bochdalek hernia in an adult. Cir Esp 2023; 101:208-212. [PMID: 35792247 DOI: 10.1016/j.cireng.2022.06.049] [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: 03/28/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
Congenital diaphragmatic hernia incidence is one in 3000 live births, Bochdalek hernia occurs through a posterolateral defect. It is very rare in adults. We present a case of late relapsed one diagnosed in an adult male. He underwent an open intervention of Bochdalek hernia at first day of life and required reintervention at seventh month due to recurrence. Now, computerized tomography scan demonstrates a right diaphragmatic defect with intrathoracic hydronephrotic kidney. Nephrectomy was performed with Video-assisted Thoracic Surgery using laparoscopic ports and material. The diaphragmatic defect was closed with a polypropylene mesh. The patient was discharged after 72 h.
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Affiliation(s)
- Mónica Sanz Del Pozo
- Department of Urology, Quironsalud Zaragoza Hospital, Mariano Renovales, 50006, Spain.
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15
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Li B, Liu F, Wu G, Ma Q. Retroperitoneal totally endoscopic prosthetic (R-TEP) repair of a right-sided Bochdalek hernia. Asian J Surg 2023:S1015-9584(23)00115-X. [PMID: 36732196 DOI: 10.1016/j.asjsur.2023.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Affiliation(s)
- Binggen Li
- Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China
| | - Feng Liu
- Department of General Surgery, The People's Hospital of Wuhai Inner Mongolia, Wuhai, 016000, China.
| | - Guangming Wu
- Department of General Surgery, The People's Hospital of Wuhai Inner Mongolia, Wuhai, 016000, China
| | - Qiang Ma
- Department of General Surgery, The People's Hospital of Wuhai Inner Mongolia, Wuhai, 016000, China
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16
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Mohammed S, El-Basheir H. Obstructed Bochdalek hernia in an adult. Oxf Med Case Reports 2022; 2022:omac138. [PMID: 36540842 PMCID: PMC9759938 DOI: 10.1093/omcr/omac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022] Open
Abstract
Congenital diaphragmatic hernia is a common neonatal anomaly. Presentation beyond childhood, however, is rare. We report, here, the case of a woman in her 50s who presented with an acutely obstructed posterolateral diaphragmatic hernia. The initial physical exam and radiological results could have led to an erroneous diagnosis of pneumothorax. We wish to emphasize the importance of having a high index of suspicion for this condition when cases with similar gastro-respiratory symptoms are encountered.
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Affiliation(s)
- Salih Mohammed
- Correspondence address. Anaesthesia department, Galway University Hospitals, Newcastle Rd, Galway H91 YR71, Ireland. E-mail:
| | - Hatim El-Basheir
- Royal care International Hospital, Cardiothoracic Surgery, Khartoum, Sudan
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17
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Hemanth Rathod R, Rajan YRD, Potluri V. Congenital Right Diaphragmatic Hernia Presenting in Adult Life: A Rare Case. Cureus 2022; 14:e31168. [DOI: 10.7759/cureus.31168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/08/2022] Open
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18
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Hietaniemi H, Järvinen T, Ilonen I, Räsänen J. Congenital diaphragmatic hernia in adults: a decade of experience from a single tertiary center. Scand J Gastroenterol 2022; 57:1291-1295. [PMID: 35658774 DOI: 10.1080/00365521.2022.2081818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Congenital diaphragmatic hernias (CDHs) in adults remain rare, with limited data on them available. However, CDHs can cause respiratory and gastrointestinal symptoms in adults, even resulting in the strangulation of the bowel when incarcerated. Here, we aimed to analyze surgical outcomes among adult patients. The primary outcome of interest was the complication rate, reoperations and 90-day mortality after laparoscopic and open hernia repair. METHODS We identified all adult patients diagnosed with a Morgagni or Bochdalek hernia treated operatively between 2010 and 2019 in a single tertiary care hospital. Data on patient demographics, surgical characteristics, mortality and morbidity were collected. RESULTS In total, we identified 37 patients (67.6% female; average age, 57 years). Overall, 78.4% patients underwent minimally invasive operations, while 35.1% underwent emergency operations. A Clavien-Dindo grade II-V complication was experienced by 18.9% of patients. No deaths occurred within 90 days of surgery, and we detected no recurrences in short-term or long-term follow-up. A minimally invasive technique correlated with a shorter hospital stay of 3.6 days versus 6.8 days in the open surgery group (p = .007, t = 3.3, 95% confidence interval = 1.04-5.21). CONCLUSION Our findings indicate that the laparoscopic repair of a congenital diaphragmatic hernia is safe and effective, offering short hospital stay and a low amount of complications.
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Affiliation(s)
- Henriikka Hietaniemi
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Surgery, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Tommi Järvinen
- Department of Surgery, Faculty of Medicine, Helsinki University, Helsinki, Finland.,Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Ilonen
- Department of Surgery, Faculty of Medicine, Helsinki University, Helsinki, Finland.,Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Jari Räsänen
- Department of Surgery, Faculty of Medicine, Helsinki University, Helsinki, Finland.,Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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19
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Nistri C, Marinelli L, Di Giacomo A, Bonariol L, Massani M. Robotic repair of a giant Larrey-type congenital left-sided diaphragmatic hernia in a young woman. A case report and literature review. Int J Surg Case Rep 2022; 98:107507. [PMID: 36027832 PMCID: PMC9424357 DOI: 10.1016/j.ijscr.2022.107507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Congenital diaphragmatic hernia is a rare condition caused by a malformation in the diaphragm that is usually diagnosed in newborns, infants and children. Sometimes it can be incidentally identified in adults. Once the diagnosis is made, surgery is indicated to avoid the risk of life-threatening complications of herniated viscera. Traditional approaches include laparotomy or thoracotomy or both; in the last decades minimally invasive techniques have proved to be a safe alternative to the open approach but only few cases of robotic hernia repair have been described so far, the most with a combined thoracic-abdomen approach. We report a case of an 18-year-old female presenting with abdominal pain due to a giant left-sided anterior diaphragmatic hernia (Larrey-type) that was repaired using a robotic-assisted laparoscopic approach with mesh placement. The hernia contents included gastric body and fundus, duodenum, jejunum, ileus, cecum, right colon and mesentery; spleen and pancreas were rotated and dislocated anteriorly. The outcome was unremarkable, with no major post-operative complications and no signs of long-term recurrence. The robotic approach seems to be a valid option for the treatment of diaphragmatic hernias, improving post-operative outcome and providing surgeon better visualization, greater precision and enhanced dexterity in a confined space. Congenital diaphragmatic hernias are a rare condition that may have a late onset. Once the diagnosis is made, surgery is mandatory due to the risk of life-threatening complications. Minimally invasive approaches are a safe option for congenital diaphragmatic hernia repair and can improve post-operative outcome. Robotic diaphragmatic hernia repair allows better visualization, greater precision and enhanced dexterity in a confined space. The use of a mesh is controversial, but in large defects it is recommended to reinforce the primary repair.
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Affiliation(s)
- C Nistri
- Chirurgia 1, Ospedale di Treviso Ca' Foncello, ULSS 2 Marca Trevigiana, Treviso, Italy.
| | - L Marinelli
- Chirurgia 1, Ospedale di Treviso Ca' Foncello, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - A Di Giacomo
- Chirurgia 1, Ospedale di Treviso Ca' Foncello, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - L Bonariol
- Chirurgia 1, Ospedale di Treviso Ca' Foncello, ULSS 2 Marca Trevigiana, Treviso, Italy
| | - M Massani
- Chirurgia 1, Ospedale di Treviso Ca' Foncello, ULSS 2 Marca Trevigiana, Treviso, Italy
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20
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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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21
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Kian B, kayedi M, Teimouri A. Intrathoracic kidney: A rare presentation of ectopic kidney. Radiol Case Rep 2022; 17:2795-2797. [PMID: 35677702 PMCID: PMC9167872 DOI: 10.1016/j.radcr.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
The thoracic kidney is the rarest form of renal ectopia. Furthermore, it is usually asymptomatic and discovered incidentally. It is seen as a mass in the posterior mediastinum or juxta-diaphragmatic on chest radiography. A computed tomography scan or magnetic resonance imaging is usually needed for a definitive diagnosis. The thoracic kidney typically exits the retroperitoneal space through the foramen of Bochdalek.
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22
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Koliakos N, Tzortzis AS, Bakopoulos A. Re: Bochdalek hernias in the adult population: a systematic review of the literature. ANZ J Surg 2022; 92:1964. [PMID: 35950668 DOI: 10.1111/ans.17758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Nikolaos Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anargyros Bakopoulos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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23
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Koliakos N, Tzortzis AS, Papaconstantinou D. Comment to: A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway. Hernia 2022; 26:1199-1200. [PMID: 35666400 DOI: 10.1007/s10029-022-02628-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 11/04/2022]
Affiliation(s)
- N Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
| | - A-S Tzortzis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - D Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini Str. 1, 12462, Athens, Greece
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24
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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: 0.5] [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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25
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First case of a patient with left Bochdalek congenital diaphragmatic hernia and congenital bicuspid aortic valve stenosis undergoing Perceval bioprosthetic aortic valve replacement via mini-thoracotomy one-lung anesthesia. Asian J Surg 2022; 45:1742-1743. [PMID: 35184960 DOI: 10.1016/j.asjsur.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
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26
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Ramspott JP, Regenbogen S, Jäger T, Lechner M, Mayer F, Gabersek A, Emmanuel K, Schredl P. Case Report: Adult Right-Sided Bochdalek Hernia Complicated by Intrathoracic Bowel Perforation. Front Surg 2021; 8:755279. [PMID: 34869563 PMCID: PMC8639588 DOI: 10.3389/fsurg.2021.755279] [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: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Right-sided Bochdalek hernia is a mostly congenital condition of the diaphragm caused by a persistence of the pleuroperitoneal cavity and a rare disease in adults. As it often presents as an emergent situation, urgent diagnostics and surgical intervention are essential to reduce morbidity and mortality rates. Choosing the right surgical approach (abdominal, thoracic, or a combination of both) can be very challenging for clinicians. Here, we report a case of a 40-year-old woman, who presented with severe abdominal pain and tachypnoea. Imaging revealed a right-sided Bochdalek hernia. Emergency laparotomy was performed followed by reduction of hernia content, right-sided hemicolectomy, and side-to-side anastomosis from the ileum to the transverse colon due to intestinal ischemia and intrathoracic bowel perforation. The post-operative course was complicated by a pleural empyema. Therefore, the patient underwent thoracotomy. One year after surgical repair the patient had no recurrence. Here, we discuss feasible approaches for the surgical management of complicated Bochdalek hernias.
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Affiliation(s)
- Jan Philipp Ramspott
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria.,Department of Gynecology and Obstetrics, Münster University Hospital, Münster, Germany
| | - Stephan Regenbogen
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria.,Department of Trauma Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Michael Lechner
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Franz Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Ana Gabersek
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
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27
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Salcedo G, Velez F, Posada M, Barragan C, Vorwald P. Right-sided Bochdalek hernia associated with an intrathoracic kidney in an adult. Surgery 2021; 170:e13-e14. [PMID: 34602185 DOI: 10.1016/j.surg.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gabriel Salcedo
- Department of Surgery, Hospital Fundacion Jimenez Diaz, Madrid, Spain. https://twitter.com/gsalcedoca
| | - Felipe Velez
- Department of Surgery, Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Maria Posada
- Department of Surgery, Hospital Fundacion Jimenez Diaz, Madrid, Spain. https://twitter.com/MariaPosGlez
| | - Cristina Barragan
- Department of Surgery, Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Peter Vorwald
- Department of Surgery, Hospital Fundacion Jimenez Diaz, Madrid, Spain
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28
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Sullivan TM, Ruch BC, Vudatha V, Julliard WA, Shah RD. Bochdalek Hernia with Gastric Necrosis Requiring Roux-en-Y Esophagojejunostomy. Ann Thorac Surg 2021; 113:e449-e451. [PMID: 34582760 DOI: 10.1016/j.athoracsur.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/24/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Bochdalek hernias are the most common congenital diaphragmatic hernias and are usually diagnosed during childhood1. They can present in adulthood and, in uncommon circumstances, result in gastric herniation with strangulation. We present a case of an adult Bochdalek hernia resulting in total gastric necrosis necessitating Roux-en-Y esophagojejunostomy in an otherwise healthy 39-year-old male. This case highlights the potential morbidity associated with unrepaired congenital diaphragmatic hernias and the need for appropriate referral.
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Affiliation(s)
- Travis M Sullivan
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA.
| | - Brianna C Ruch
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Walker A Julliard
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Surgery, Division of Thoracic and Foregut Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Rachit D Shah
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA; Department of Surgery, Division of Thoracic and Foregut Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
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29
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Nambara S, Sakaguchi Y, Shoji F, Tsuda Y, Kudou K, Kusumoto E, Hashimoto K, Kusumoto T, Ikejiri K. Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report. Surg Case Rep 2021; 7:214. [PMID: 34546461 PMCID: PMC8455731 DOI: 10.1186/s40792-021-01294-5] [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: 03/12/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited. CASE PRESENTATION A 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient's postoperative course was uneventful with no recurrences within the first year post-surgery. CONCLUSION Combined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.
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Affiliation(s)
- Sho Nambara
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Yoshihisa Sakaguchi
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Fumihiro Shoji
- Department of Thoracic Surgery, National Kyushu Medical Center, 1-8-1 Jigyohama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Yasuo Tsuda
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kensuke Kudou
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Eiji Kusumoto
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kenkichi Hashimoto
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
| | - Koji Ikejiri
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, 1-8-1 Jigyouhama Chuo-ku, Fukuoka, 810-8563, Japan
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Pun A, Dhoubhadel P, Dawadi K. Right-sided Bochdalek hernia in an adult: a case report. J Surg Case Rep 2021; 2021:rjab357. [PMID: 34466216 PMCID: PMC8403501 DOI: 10.1093/jscr/rjab357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 07/24/2021] [Indexed: 11/14/2022] Open
Abstract
Bochdalek hernia (BH) is the most common type of congenital diaphragmatic hernia and is usually left-sided. It typically presents in neonates and diagnosis in adults is a rarity. To date only 34 reported cases of right-sided BH have been surgically managed in adults in literature. We review a 21-year-old female with a right-sided BH diagnosed as acute calculus cholecystitis and underwent laparoscopic cholecystectomy. The diagnosis of BH was made incidentally during surgery. The hernia did not have a sac with no hernial contents. It was treated via laparoscopic intracorporeal suturing and patient postoperative period was uneventful. Right-sided BH is rare. Regardless of the symptoms surgical treatment should be done to avoid risk of visceral strangulation.
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Affiliation(s)
- Asish Pun
- MS General Surgery, Department of General Surgery, Bharatpur Hospital, Chitwan, Nepal
| | - Pratibha Dhoubhadel
- MS General Surgery, Department of General Surgery, Bharatpur Hospital, Chitwan, Nepal
| | - Kamal Dawadi
- MD Internal Medicine, Department of Internal Medicine, Hetauda Hospital, Makwanpur, Nepal
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Kozadinos A, Chrysikos D, Davakis S, Kozadinos I, Farmakis P, Georgiou G, Troupis T. Bochdalek hernia with intrathoracic spleen treated by robotic-assisted mesh repair utilizing indocyanine green contrast media intraoperatively. A case report. J Surg Case Rep 2021; 2021:rjab352. [PMID: 34408844 PMCID: PMC8367440 DOI: 10.1093/jscr/rjab352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/24/2021] [Indexed: 11/13/2022] Open
Abstract
Bochdalek hernias are usually diagnosed in newborns. However, they can occur in adults. Few reports exist regarding robotic repair of such hernias. We present a case of a female patient with symptomatic Bochdalek hernia, including the spleen. Patient was successfully treated by robotic-assisted surgical mesh with the use of indocyanine green (ICG). An 80-year-old female patient presented with dyspnea, angina and intermittent abdominal pain. She had loss of appetite and 15-kg weight loss within 3 months. Past medical history was unremarkable. Imaging revealed a left Bochdalek hernia. The patient underwent robotic-assisted surgery; hernia contents included stomach, parts of colon, omentum and remarkably the spleen. Sac was dissected free. Patency of organs was assessed with ICG. Diaphragmatic defect was repaired with mesh. Bochdalek hernias should be surgically repaired. Minimally invasive therapy is safe and effective. Intraoperative ICG use can provide excellent results with favorable clinical outcomes.
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Affiliation(s)
- Alexandros Kozadinos
- Department of Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Davakis
- Department of Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kozadinos
- A' Robotic and Minimal Invasive General Surgery Department of Metropolitan Hospital of Athens, Athens, Greece
| | - Panagiotis Farmakis
- A' Robotic and Minimal Invasive General Surgery Department of Metropolitan Hospital of Athens, Athens, Greece
| | - Georgios Georgiou
- A' Robotic and Minimal Invasive General Surgery Department of Metropolitan Hospital of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports. Diagnostics (Basel) 2021; 11:diagnostics11071261. [PMID: 34359342 PMCID: PMC8303225 DOI: 10.3390/diagnostics11071261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Since the first report of a diaphragmatic hernia from Ambroise Paré’s necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early. Data sources and study selection: A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups’ presence due to their rarity. Results: The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases. Conclusion: Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.
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A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway. Hernia 2021; 26:47-59. [PMID: 34216313 PMCID: PMC8881253 DOI: 10.1007/s10029-021-02445-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/10/2021] [Indexed: 12/29/2022]
Abstract
Purpose Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed. Results Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented. Conclusion This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02445-1.
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Diaphragmatic Hernia in Pregnancy. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tufiño J, Espin S, Reyes MC, Zumárraga F, Marcelo Cevallos J, Molina GA, González H. Bochdalek hernia in a young adult successfully treated with a laparoscopic approach, a case report. Ann Med Surg (Lond) 2021; 65:102279. [PMID: 33948164 PMCID: PMC8080451 DOI: 10.1016/j.amsu.2021.102279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background Bochdalek hernias are a rare form of diaphragmatic hernias; they are frequently found in children; however, they have been discovered in completely asymptomatic adults in exceptional situations. Being such a unique pathology, they can be easily confused and misdiagnose, exposing patients to unnecessary treatments. Case report Patient is an otherwise healthy 30-year-old patient without past medical history; after vigorous physical activity, a Bochdalek hernia was discovered and successfully treated; on follow-ups, he is doing well without signs of recurrence. Conclusions In adults, Bochdalek hernia is an uncommon form of diaphragmatic hernia. As most cases are asymptomatic, a high index of suspicion is needed since diagnosis is challenging. Modern surgical techniques can improve patient recovery and short hospital stay with minimal morbidity or mortality.
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Affiliation(s)
- Jorge Tufiño
- Hospital General San Francisco, Iess, Quito, Ecuador
| | | | | | | | | | - Gabriel A Molina
- IESS Quito Sur and Universidad San Francisco de Quito (USFQ), Quito, Ecuador
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Abstract
The purpose of this image is to illustrate a Bochdalek hernia diagnosis in a 39-year-old female patient treated on an emergency basis by means of CT-scan and following perioperative observation. Treatment consisted in initial laparoscopy that due to irreducible bowel incarceration was converted into hernia repair surgery through simple suture and thoracic drainage.
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Affiliation(s)
- A Marichez
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Haut Lévêque hospital, CHU de Bordeaux, Bordeaux, France; Medico-surgical center Magellan, 1, avenue de Magellan, 33600 Pessac, France.
| | - B Fernandez
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Haut Lévêque hospital, CHU de Bordeaux, Bordeaux, France; Medico-surgical center Magellan, 1, avenue de Magellan, 33600 Pessac, France
| | - L Chiche
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Haut Lévêque hospital, CHU de Bordeaux, Bordeaux, France; Medico-surgical center Magellan, 1, avenue de Magellan, 33600 Pessac, France
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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: 1.0] [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: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
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Harris KB, Brateanu A. Recurrent syncope while eating: an unusual presentation of a diaphragmatic hernia. BMJ Case Rep 2020; 13:13/4/e233641. [PMID: 32341089 DOI: 10.1136/bcr-2019-233641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kevin B Harris
- Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andrei Brateanu
- Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Akita M, Yamasaki N, Miyake T, Mimura K, Maeda E, Nishimura T, Abe K, Kozuki A, Yokoyama K, Kominami H, Tanaka T, Takamatsu M, Kaneda K. Bochdalek hernia in an adult: two case reports and a review of perioperative cardiopulmonary complications. Surg Case Rep 2020; 6:72. [PMID: 32303918 PMCID: PMC7165220 DOI: 10.1186/s40792-020-00833-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bochdalek hernia in an adult is very rare and often needs an immediate surgical repair for the herniation. Although its etiology and surgical techniques have frequently been reported, perioperative complications, especially cardiopulmonary problems, remain unknown. We reported two adults with Bochdalek hernia and reviewed the published literatures with a focus on these issues. Case presentation We experienced two adult cases of Bochdalek hernia with gastrointestinal strangulation. One case had massive herniation of the stomach, colon, spleen, and pancreas in the left chest, causing repeated vomiting. The other had a right-side hernia with strangulation of the colon. We successfully performed emergency repairs of these diaphragmatic hernias without any postoperative complications. Conclusions Our literature review revealed that life-threatening cardiopulmonary complications, such as empyema or cardiac arrest caused by the tamponade effect of the herniated viscera, sometimes occurred in patients with Bochdalek hernia. These complications were found in Bochdalek hernia with gastrointestinal strangulation.
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Affiliation(s)
- Masayuki Akita
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan.
| | - Nobuaki Yamasaki
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Taiichiro Miyake
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Kazuya Mimura
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Eri Maeda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Tohru Nishimura
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Koichiro Abe
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Akihito Kozuki
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Kunio Yokoyama
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Hiroaki Kominami
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Tomohiro Tanaka
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Manabu Takamatsu
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
| | - Kunihiko Kaneda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa, 675-8611, Japan
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Mariolis-Sapsakos T, Zarokosta M, Anastasiou N, Noussios G, Filippou D. Standard and Variable Key Anatomical Structures for Safe Surgical Repair of Bochdalek Hernia: A Rare Case Series. Cureus 2019; 11:e6018. [PMID: 31824786 PMCID: PMC6886660 DOI: 10.7759/cureus.6018] [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] [Indexed: 11/05/2022] Open
Abstract
Bochdalek hernia (BH) is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the thoracic viscera. This type of hernia is rare in adults, usually asymptomatic and may be diagnosed incidentally in a routine chest X-ray. The aim of the present retrospective study was to highlight the standard and important anatomical structures that are crucial to safe surgical repair of BH during laparotomy and thoracotomy by the placement of mesh graft, along with a short review of the existing evidence. Records from 2005 to 2017 were reviewed to identify the patients with adult BH who underwent mesh repair through thoracotomy or laparotomy and evaluate the possible complications and results. Six patients were operated for adult BH with the above-mentioned techniques. Four underwent laparotomy and two were treated through thoracotomy. Mild fever was reported only in one patient. There was significant improvement in the symptoms of all patients and no recurrence was reported in the subsequent follow-up period. Surgical treatment is strongly indicated for both symptomatic and asymptomatic patients. Surgeons' in-depth knowledge of the anatomy of the diaphragm will ensure better outcomes for the patients.
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Affiliation(s)
| | - Maria Zarokosta
- General Surgery, Agii Anargiri Oncological Hospital, Athens, GRC
| | | | - George Noussios
- Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Dimitrios Filippou
- Surgery, Medical School of National and Kapodistrian University of Athens, Athens, GRC
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Lirici MM, Bongarzoni V, Paolantonio P, Leggeri T, Pirillo SP, Romeo V. Minimally invasive management of rare giant Bochdalek hernia in adults. MINIM INVASIV THER 2019; 29:304-309. [PMID: 31298588 DOI: 10.1080/13645706.2019.1641523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bochdaleck hernia (BH) is a congenital diaphragmatic hernia that presents after birth with respiratory symptoms and needs surgical treatment in the neonatal period. However, there are some rare cases of adult presentation, which require surgery to avoid complications. BHs can be treated through several approaches, including laparoscopy. Laparoscopic treatment of a giant BH was successfully attempted on a woman affected by multiple myeloma, with severe dyspnoea and dysphagia. Preoperative work-up included chest X ray, CT-scan and MRI. The whole stomach, duodenum, the small bowel, the right and transverse colon, most descending colon and the pancreas were herniated into the thorax. The herniated viscera were totally reduced into the abdominal cavity and the large defect of the left diaphragm repaired with a biosynthetic web scaffold especially designed for diaphragmatic reconstruction. Finally, to avoid a compartment syndrome in an abdomen with not enough room for the reduced viscera, an extended right colectomy with extracorporeal anastomosis was carried out through a mini-laparotomy. At seven-month follow-up, the patient is symptomless and control CT scan showed no hernia recurrence. Laparoscopic repair of large symptomatic adult BHs can be performed successfully with significant clinical improvement, even in difficult cases and fragile patients.
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Affiliation(s)
- Marco Maria Lirici
- Department of Surgery, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | - Velia Bongarzoni
- Department of Hematology, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | | | - Tatiana Leggeri
- Department of Surgery, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | | | - Valentina Romeo
- Department of Surgery, San Giovanni Addolorata Hospital Complex, Rome, Italy
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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: 9] [Impact Index Per Article: 1.8] [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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Perfecto Valero A, Serrano Hermosilla C, Fernández Fernández J. Left Bochdalek Hernia Containing Intrathoracic Kidney. Arch Bronconeumol 2019; 55:587. [PMID: 30885543 DOI: 10.1016/j.arbres.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Arkaitz Perfecto Valero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Bizkaia, España.
| | - Clara Serrano Hermosilla
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - June Fernández Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Basurto, Bilbao, Bizkaia, España
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Sabah SA, Haddad EA, Vaz JD. Repair of a giant diaphragmatic hernia using the dual approach. J Surg Case Rep 2019; 2019:rjz064. [PMID: 30886697 PMCID: PMC6413371 DOI: 10.1093/jscr/rjz064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/13/2019] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
Bochdalek hernias are diaphragmatic defects seen in pediatrics. About 5–25% of the cases are diagnosed in adulthood, and present with symptoms of chest and abdominal problems. This is a case of an 18-year-old male who presented to the emergency department with epigastric pain, vomiting and dyspnea. Most of the left-sided organs had herniated to the left chest cavity. Immediate surgery was performed. The stomach, spleen and colon were reduced into the abdominal cavity. The diaphragm defect was repaired laparoscopically, but there were limitations due to inadequate space, leading to difficult visualization of the posterior diaphragmatic leaflet. A thoracoscopic approach was taken where we saw the left kidney herniated through the repair site posteriorly. It was reduced and the defect was closed. The early diagnosis of Bochdalek hernias is important to prevent stomach/intestinal strangulation. Laparoscopic surgeons need to be prepared for a thoracic approach in giant congenital diaphragmatic hernias.
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Affiliation(s)
| | | | - Jonathon D Vaz
- Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
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Maibom SL, Ryom P, Schou-Jensen K. Left sided flank pain due to Bochdalek hernia with intrathoracic kidney. Scand J Urol 2019; 53:79-80. [PMID: 30653382 DOI: 10.1080/21681805.2018.1545798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
| | - Phillip Ryom
- b Department of Thoracic Surgery , Rigshospitalet , Denmark
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Tan CQY, Chan DL, Chu F, Fisher OM. Rare presentation of a Bochdalek hernia in adulthood with incarcerated splenic flexure of the colon mimicking diverticulitis: a report and review. ANZ J Surg 2018; 89:1518-1520. [PMID: 30497098 DOI: 10.1111/ans.14945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Charis Q Y Tan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Francis Chu
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia
| | - Oliver M Fisher
- Department of Surgery, St George Hospital, Sydney, New South Wales, Australia.,Department of Surgery, The University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, The University of Notre Dame Australia, Sydney, New South Wales, Australia.,St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
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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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Lee JS, Kim ES, Jung MK, Kim SK, Jin S, Lee DH, Seo JW. An Unexpected Adverse Event during Colonoscopy Screening: Bochdalek Hernia. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:290-293. [PMID: 29791989 DOI: 10.4166/kjg.2018.71.5.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Bochdalek hernia (BH) is defined as herniated abdominal contents appearing throughout the posterolateral segment of the diaphragm. It is usually observed during the prenatal or newborn period. Here, we report a case of an adult patient with herniated omentum and colon due to BH that was discovered during a colonoscopy. A 41-year-old woman was referred to our hospital with severe left chest and abdominal pain that began during a colonoscopy. Her chest radiography showed colonic shadow filling in the lower half of the left thoracic cavity. A computed tomography scan revealed an approximately 6-cm-sized left posterolateral diaphragmatic defect and a herniated omentum in the colon. The patient underwent thoracoscopic surgery, during which, the diaphragmatic defect was closed and herniated omentum was repaired. The patient was discharged without further complications. To the best of our knowledge, this case is the first report of BH in an adult found during a routine colonoscopy screening.
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Affiliation(s)
- Joon Seop Lee
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Min Kyu Jung
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sung Kook Kim
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sun Jin
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Korea
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Susmallian S, Raziel A. A Rare Case of Bochdalek Hernia with Concomitant Para-Esophageal Hernia, Repaired Laparoscopically in an Octogenarian. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1261-1265. [PMID: 29184050 PMCID: PMC5716375 DOI: 10.12659/ajcr.906225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 81 Final Diagnosis: Bochdalex hernia Symptoms: Chest pain • vomiting Medication: — Clinical Procedure: Laparoscopic repair of both diaphragmatic hernias Specialty: Surgery
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