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Balzano RF, Fascia G, Sciacqua A, Guglielmi G. Incidental finding of Bochdalek hernia in an adult: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023246. [PMID: 37850760 PMCID: PMC10644929 DOI: 10.23750/abm.v94i5.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023]
Abstract
A Bochdalek hernia, also known as a congenital diaphragmatic hernia (CDH), is a type of hernia that occurs in infants. The diaphragm, the muscle that separates the chest cavity from the abdominal cavity, is characterized by a hole or gap during birth. This opening allows the abdominal organs, such as the stomach, intestines, or liver, to pass through the thoracic cavity. Here, we report a 56-year-old male patient who came to our hospital because of rectal bleeding, symptoms unrelated to the hernia. We performed a Computed Tomography (CT) scan with contrast enhancement to find the cause of the bleeding and as an incidental finding we diagnosed the hernia: it is very rare to find a silent Bochdalek hernia for more than 50 years.
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Affiliation(s)
| | - Giacomo Fascia
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy.
| | - Alessio Sciacqua
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy.
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Kimura Y, Ishioka D, Kamiyama H, Tsujinaka S, Rikiyama T. Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report. Surg Case Rep 2021; 7:206. [PMID: 34529186 PMCID: PMC8446140 DOI: 10.1186/s40792-021-01291-8] [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: 07/06/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA. CASE PRESENTATION An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted. CONCLUSIONS Laparoscopic surgery seems useful and feasible for strangulated DH.
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Affiliation(s)
- Yasuaki Kimura
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan. .,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Daisuke Ishioka
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan.,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hidenori Kamiyama
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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When laparoscopic repair is feasible for diaphragmatic hernia in adults? A retrospective study and literature review. Surg Endosc 2021; 36:3347-3355. [PMID: 34312729 DOI: 10.1007/s00464-021-08651-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diaphragmatic hernia (DH), congenital or traumatic, is uncommon but sometimes can lead to a serious surgical emergency. There are no clinical guidelines or approved recommendations for the management of this condition, and most data are from retrospective, single-institution series. The aim is to analyze the management of the DH at our institution and review the indications for laparoscopic repair. METHODS A retrospective serie of patients diagnosed of DH with surgical treatment at our institution between 2009 and 2019. Literature review was carried out to establish the current indications of laparoscopic repair in each type of DH. RESULTS Surgery was carried out in 15 patients with DH, 5 congenital and 10 traumatic hernias. Traumatic hernias were classified as acute (n = 2) and chronic (n = 8). 53.4% of all cases (8 patients) required urgent surgery using an abdominal approach (5 open and 3 laparoscopic) and elective surgery was performed in 46.6% of all cases (7 patients) with an abdominal approach (3 open and 4 laparoscopic) and 2 patients with a combined approach. Primary repair was performed in 4 patients (26.6%), closure and mesh reinforcement in 9 cases (60%) and only mesh placement in 2 patients (13.4%). Postoperative morbidity and mortality were 20% and 0%, respectively. No recurrences were detected. CONCLUSIONS DH may pose different scenarios which require urgent or elective surgical treatment. Laparoscopic approach may be a first option in elective surgery; and in emergency setting taking into account hemodynamic stability and associated injuries.
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Bono D, Arnone G, Suppo M, Saracco R. Laparoscopic cholecystectomy in adult with asymptomatic partial agenesis of the right diaphragm: Case report and the literature. Int J Surg Case Rep 2020; 77S:S21-S24. [PMID: 33172810 PMCID: PMC7876735 DOI: 10.1016/j.ijscr.2020.10.023] [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: 07/08/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022] Open
Abstract
Diaphragmatic agenesis is a rare condition. In adults with partial diaphragmatic agenesis, laparoscopic cholecystectomy can be performed successfully. A conservative management only with gallstones dissolution therapy can be used if laparoscopy cannot be done.
Introduction The importance of unilateral diaphragmatic agenesis (DA) in adults for performing a laparoscopic cholecystectomy has not been well described in literature. Presentation of case A 60-year-old female patient entered our ward in March 2019 for laparoscopic cholecystectomy after 6 months history of epigastric pain and multiple episodes of biliary colic treated conservatively. She never complained of pulmonary symptoms. Preoperative chest Computed tomography (CT) was negative for diaphragmatic or pulmonary pathologies. Laparoscopic cholecystectomy was performed in 60 min with intraoperative detection of a thoracoabdominal communication with partial right hemidiaphragm agenesis. A chest CT and x-ray were performed in the postoperative period with progressive reduction of an asymptomatic small pneumothorax. The patient was discharged at home without complications on the fifth postoperative day. Thoracopulmonary surgery examination was performed without indications for diaphragmatic repair. Discussion DA is a rare condition and usually occurs in early neonatal period. The congenital form occurs in 1 out of 2200–12500 live births and is traditionally divided into anterior (Morgagni’s: 10%) and posterolateral (Bochdalek’s: 90%) hernias. Chest and abdomen CT with coronal and sagittal reconstructions is the most effective and useful imaging technique for the diagnosis of diaphragmatic hernia. In literature there are former two case reports of asymptomatic DA in cholelithiasis in which laparoscopic cholecystectomy was performed effectively. Conclusion In adults with partial DA, laparoscopic cholecystectomy can be performed successfully. A conservative management only with gallstones dissolution therapy can be used if laparoscopy cannot be done. Further studies with a higher level of evidence are needed.
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Affiliation(s)
- Dario Bono
- Department of General Surgery, Martini Hospital, 91 Via Tofane, 10141, Turin, Italy.
| | - Giovanni Arnone
- Department of General Surgery, Martini Hospital, 91 Via Tofane, 10141, Turin, Italy.
| | - Monica Suppo
- Department of General Surgery, Martini Hospital, 91 Via Tofane, 10141, Turin, Italy.
| | - Roberto Saracco
- Department of General Surgery, Martini Hospital, 91 Via Tofane, 10141, Turin, Italy.
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Azam A, Michael K. Postnephrectomy diaphragmatic hernia presenting as progressive dyspnoea. BMJ Case Rep 2020; 13:13/10/e235881. [PMID: 33127732 DOI: 10.1136/bcr-2020-235881] [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: 11/04/2022] Open
Abstract
The diagnosis of diaphragmatic hernia (DH) in adults is rare and may be due to missed congenital DH or acquired DH from trauma or as a postoperative complication of certain thoracic and abdominal surgeries. We present a case of a patient with well-controlled chronic obstructive pulmonary disease who presented to the hospital with progressive dyspnoea, 6 months after laparoscopic nephrectomy. The patient was initially misdiagnosed and treated for empyema after plain radiographic images were reported as consolidation with gas locules. Multislice CT imaging undertaken before diagnostic thoracocentesis confirmed the presence of a right-sided DH, which was subsequently surgically repaired in the outpatient setting, given her haemodynamic stability. As patients with DH usually present in the emergency setting, requiring urgent inpatient surgical repair, there are currently no guidelines on the method and urgency of management of asymptomatic or mildly symptomatic, stable patients. Furthermore, while plain radiography is the usual first-line imaging modality used, misdiagnosis of DH as pleural effusion or empyema can lead to unnecessary and potentially harmful procedures such as diagnostic thoracocentesis. These risks can potentially be minimised with early utilisation of multislice CT imaging in patients with high clinical suspicion.
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Affiliation(s)
- Aqeem Azam
- Respiratory Medicine, Stepping Hill Hospital, Stockport, UK
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Lee J, Nam SH, Kim SW, Hong JM, Kim D. Diaphragmatic hernia with isolated shoulder pain evoked by surfeit. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:11. [PMID: 30788358 DOI: 10.21037/atm.2018.11.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bochdalek hernia in adult is extremely rare, so symptoms or indications of surgery are not reported enough. Here we report a case of small-sized Bochdalek hernia with isolated shoulder pain that resolved after surgical reduction of hernia. A 25-year-old man with diaphragmatic mass was referred to out-patient clinic. Chief complaint was an isolated left shoulder pain evoked by surfeit. Diaphragmatic hernia was suggested on chest computed tomography (CT) but it was not certain. So, video-assisted thoracic surgery (VATS) exploration was planned to clarify the diagnosis. The mass was proven to be the Bochdalek hernia and successfully restored into abdominal cavity. There were no postoperative complications and isolated shoulder pain disappeared clearly.
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Affiliation(s)
- Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Seung Hyuk Nam
- Department of thoracic and cardiovascular Surgery, Hanyang University Guri Hospital, Guri, Gyunggi, Republic of Korea
| | - Si-Wook Kim
- Department of thoracic and cardiovascular Surgery, College of medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jong-Myeon Hong
- Department of thoracic and cardiovascular Surgery, College of medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dohun Kim
- Department of thoracic and cardiovascular Surgery, College of medicine, Chungbuk National University, Cheongju, Republic of Korea
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Moro K, Kawahara M, Muneoka Y, Sato Y, Kitami C, Makino S, Nishimura A, Kawachi Y, Gabriel E, Nikkuni K. Right-sided Bochdalek hernia in an elderly adult: a case report with a review of surgical management. Surg Case Rep 2017; 3:109. [PMID: 29030793 PMCID: PMC5640563 DOI: 10.1186/s40792-017-0385-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background Bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. In contrast, diagnosis of a Bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm. Even more rare is the diagnosis of a right-sided Bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases. Case presentation We describe a case of an 89-year-old female who presented with abdominal pain. An abdominal computed tomography (CT) scan showed decreased intravenous contrast uptake and thickening of the wall of herniated small intestine through the right side of the diaphragm, which led to the diagnosis of a strangulated diaphragmatic hernia. The patient underwent emergent laparotomy and required a partial resection of the necrotic ileum and a hernia repair with direct closure. Interestingly, in this case, organ malformation was not observed. The patient was discharged approximately 2 weeks after surgery without complication. Conclusions Adult right-sided Bochdalek hernia with strangulation in the absence of hepatic atrophy is a rare entity. Considering the severity of this condition, accurate diagnosis and proper treatment are needed. A tailored operative approach is required on an individual case basis.
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Affiliation(s)
- Kazuki Moro
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan.
| | - Mikako Kawahara
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Yusuke Muneoka
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Yu Sato
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Chie Kitami
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Shigeto Makino
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Atsushi Nishimura
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Yasuyuki Kawachi
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
| | - Emmanuel Gabriel
- Section of General Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Keiya Nikkuni
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, 940-8653, Japan
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