Acute respiratory failure caused by an incarcerated right-sided adult bochdalek hernia: report of a case

We herein report the case of a 63-year-old woman with a right-sided Bochdalek hernia. She was admitted to our hospital as an emergency patient with dyspnea and abdominal pain. A blood gas analysis showed hypoxia. A chest X-ray and computed tomography revealed a remarkable right diaphragm elevation caused by a herniation of the colon and right kidney. Under a thoracolaparotomy, a herniation of the strangulated colon and right kidney was recognized in the site of the foramen of Bochdalek, and a direct closure of the hernia opening was thus performed after repairing the location of the colon and right kidney. A right-sided Bochdalek hernia in adults is a rare clinical entity and there have been fewer than ten such cases so far reported in the world literature. This case highlights the need for a prompt diagnosis and appropriate surgical intervention. Received: January 17, 2000 / Accepted: March 5, 2002     

Thoracoscopic treatment of Bochdalek hernia in the adult: report of a case.

Bochdalek hernia is a type of congenital diaphragmatic hernia that mainly occurs in childhood, but is extremely rare in adults. A case report of Bochdalek hernia in a 17-year-old woman, complaining of left lateral upper abdominal pain is herein reported with a brief review of the literature. The herniated organs into the thoracic cavity in this case were the as stomach, large intestine, spleen and greater omentum which was diagnosed using computed tomography, an upper gastrointestinal double contrast study and irrigography. The patient was successfully treated by video-assisted thorachoscopic surgery (VATS) with a pushback method. The post-operating course was uneventful with minimal pain of the surgical wound. This case demonstrated the efficacy of the VATS repair for Bochdalek hernia.     

Laparoscopic repair of a Bochdalek hernia with incarcerated bowel during pregnancy: report of a case

A Bochdalek hernia is a rare type of diaphragmatic defect, generally presenting in early childhood with acute signs of cardiorespiratory distress. We herein report a case of acute abdomen in a pregnant patient with pain increasing when lying on her right side. Laparoscopic evaluation revealed a right-sided Bochdalek hernia with incarcerated bowel. A successful reduction was possible, and laparoscopic repair appears to be a safe and feasible technique for the repair of these hernias.     

Acute Dyspnoea Due to an Incarcerated Right-Sided Bochdalek’s Hernia

We present the case of a 76-year-old man with a right-sided Bochdalek hernia, admitted acutely with dyspnoea, abdominal distension and constipation. A chest radiograph and computed tomogram of the abdomen revealed marked elevation of the right hemidiaphragm caused by herniation of the colon. At laparotomy, strangulation of a portion of transverse colon was identified at the site of the foramen of Bochdalek. The contents of the hernia were reduced and a primary repair of the hernial orifice was performed. The segment of necrosed colon was resected and an end-to-end handsewn anastomosis was constructed.

A symptomatic Bochdalek hernia typically presents as a cardiorespiratory emergency in the neonatal period. It can remain silent and present in adulthood with chronic gastro-intestinal or respiratory symptoms. Occasionally it presents with acute dyspnoea or abdominal pain. Early detection and intervention is of the utmost importance to decrease related morbidity and mortality in adults.     

Successful laparoscopic repair of an incarcerated Bochdalek hernia associated with increased intra-abdominal pressure during use of blow gun: A case report

BackgroundBochdalek hernia is a congenital diaphragmatic hernia, and adult cases are rare, with a reported frequency of 0.17%–6% among all diaphragmatic hernias.Presentation of caseA 78-year-old man was referred to our hospital with a sudden onset of whole abdominal pain after playing with a blow gun. Chest radiography and computed tomography revealed diaphragmatic hernia with the small intestine. We therefore diagnosed him with an incarcerated Bochdalek hernia associated with increased intra-abdominal pressure during use of blow gun. Laparoscopic repair was performed. The omentum, transverse colon, and small intestine were located in the left thoracic cavity, without ischemic change. After placing the herniated organs into the abdominal cavity, we performed a primary closure of the diaphragmatic defect with interrupted non-absorbable sutures.DiscussionIt is generally recommended that all adult Bochdalek hernia patients undergo surgical repair to prevent life-threatening complications due to incarceration. Recently, laparoscopic techniques for repair the hernia have gained popularity, especially in elective cases. In our case, we could successfully perform emergency laparoscopic repair, as it is associated with a shorter inpatient hospitalization period.ConclusionAn incarcerated Bochdalek hernias associated with increased intra-abdominal pressure is an uncommon clinical finding in an adult, and laparoscopic repair of an incarcerated Bochdalek hernia is safe, feasible, and an excellent option as it is minimally invasive.     

Gunshot wound of the left chest and Bochdalek hernia

A 16-year-old male presented with a hemopneumothorax following a gunshot wound to the left chest. He was treated effectively with closed suction drainage for 48 hours when he suddenly complained of severe left chest pain. Preoperative diagnosis was suggestive of a traumatic diaphragmatic hernia but operative findings were confirmatory of a rare hernia through the foramen of Bochdalek. Chest X-ray showing a gas-filled viscus above the diaphragm is diagnostic. Increased abdominal pressure generated when he was first hit by the bullet and aggravated by increased negative intrapleural pressure resulting from suction drainage of the hemothorax is the probable mechanism of the herniation.     

Bochdalek hernia and repetitive pancreatitis in a 33 year old woman

INTRODUCTION

Bochdalek hernia presentation in adulthood is rare. The presentation in newborns is the most common, manifesting with data from respiratory failure secondary to pulmonary hypoplasia, requiring urgent surgical intervention with high morbidity and mortality.

PRESENTATION OF CASE

We present the case of a 33 year old woman admitted in the emergency room with severe abdominal pain in the left upper quadrant and disnea. After physical examination and laboratory test we diagnose mild acute pancreatitis. The patient haven’t colelitiasis by ulstrasound or any risk factor for pancreatitis. Initially she received medical treatment and was discharged after one week. After four weeks she presented the same symptoms in two different occasions, with severe and mild pancreatitis respectively. A computed tomography report a left posterolateral diafragmatic hernia. In spite of the rare association of pancreatitis and Bochdalek hernia, we realized it as the etiology until the second event and planned his surgery. We made a posterolateral torachotomy and diafragmatic plasty with a politetrafluoroetileno mesh and after a 6 months follow up she has coursed asymptomatic.

DISCUSSION

The high rate of complications in this type of hernia requires us to perform surgical treatment as the hernia is detected. In this case it is prudent medical treatment prior to surgical correction despite this being the origin of the pancreatitis, because the systemic inflammatory response added by the surgical act could result in a higher rate of complications if not performed at the appropriate time. There is no precise rule to determine the type of approach of choice in this type of hernia which thoracotomy or laparotomy may be used.

CONCLUSION

Bochdalek hernia is a rare find in adults who require treatment immediately after diagnosis because of the high risk of complications. When presented with data from pancreatitis is recommended to complete the medical treatment of pancreatitis before surgery to obtain the best results, unless it exist another abdominal complication.     

Diaphragmatic rupture during labor

Diaphragmatic rupture during labor is uncommon and generally occurs in patients with a history of congenital diaphragmatic hernia or traumatic abdominal or chest injury. We present a case of a 41-year-old woman who presented with abdominal pain, vomiting and hypoventilation four days after a full-term home delivery. Chest radiography suggested the presence of a ruptured diaphragm, and laparotomy revealed a congenital left Bochdalek defect with herniation of the stomach, transverse colon and spleen into the left pleural cavity. Diaphragmatic hernia rupture during labor is a serious but rare complication that requires emergency surgery to prevent visceral perforation and cardio-respiratory failure.     

Asymptomatic Presentation of Bochdalek’s Hernia in an Adult

Bochdalek hernia, a type of congenital diaphragmatic hernia usually presents in the immediate neonatal period with respiratory distress. Presentation in an adult is rare and asymptomatic. We report one such case of Bochdalek hernia, in a 35 year old male, who presented only with mild chest discomfort on left side. Radiological investigations were suggestive of a huge left side Bochdalek hernia with stomach and intestines in the left thorax. This case emphasizes the rarity of presentation of Bochdalek hernia in adults and the importance of high clinical suspicion and the role of imaging and surgery in the accurate diagnosis of this abnormality.     

Laparoscopic treatment of Bochdalek hernia without the use of a mesh

Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.     

Congenital posterolateral diaphragmatic hernia in an adult

A Bochdalek hernia (BH) occurs when abdominal contents herniate through the posterolateral segment of the diaphragm. Most BHs present with life-threatening cardiorespiratory distress in the neonatal period. Rarely, hernias that remain clinically silent until adulthood present as life-threatening surgical emergencies. Our recent experience with a life-threatening emergency due to a BH in a 29-year-old male patient prompted us to reinforce that this entity does exist in adults and should be considered in the differential of acute abdominal pain.     

A novel diagnosis of left paraduodenal hernia through laparoscopy

A congenital intraperitoneal hernia, also known as a "paraduodenal hernia," is an extremely rare cause of intestinal obstruction. These hernias, which are caused by variations in intestinal rotation, present with symptoms ranging from intermittent abdominal pain to acute obstruction. Preoperative diagnosis is rare, and conventional treatment is usually by laparotomy. Laparoscopic diagnosis and repair has recently been reported in Japan. We present as case of a left paraduodenal hernia diagnosed and treated laparoscopically and a review of the literature.     

Adult Bochdalek hernia with volvulus of the stomach

We report a rare case of Bochdalek hernia, congenital posterolateral diaphragmatic hernia with volvulus of the stomach, in an adult A 74-year-old man was admitted to our hospital complaining of sudden abdominal pain and vomiting. Roentgenologic examination of the chest showed air above the left diaphragm, and the mediastinum was displaced to the right. Upper gastrointestinal series revealed volvulus of the stomach in which the pylorus was displaced to the left. The surgical repair was done through left thoracotomy with combining laparoscopy and thoracoscopy without surgical complications, 1 year later the patient is asymptomatic.     

Thoracoscopic repair of a Bochdalek hernia in an adult

Bochdalek hernia is a rare congenital diaphragmatic hernia in adults. In most cases, there are no symptoms. Rarely, it requires surgical intervention. In cases with pain or visceral strangulation, laparatomy or laparoscopy are both possible. We present the case of an adult with a Bochdalek hernia. He was operated on via a thoracoscopic approach and had an uneventful recovery. We recommend the thoracoscopic approach as an alternative to open or laparoscopic approach in cases of noncomplicated Bochdalek's hernia.     

Chronic liver herniation through a right Bochdalek hernia with acute onset in adulthood

Congenital right diaphragmatic hernia of Bochdalek rarely occurs in adults and usually is asymptomatic. We report a right Bochdalek hernia with chronic liver herniation and intestinal malrotation in a 55-year old woman who presented with acute intestinal occlusion. The diagnosis required definitive confirmation by CT scan. With impending strangulation, emergency surgery through a thoracoabdominal approach resulted in an easy hernia repair and reduced the technical difficulties due to the intestinal malrotation.     

Strangulated Umbilical Hernia Including a Mesenteric Cyst: a Rare Cause of Acute Abdomen

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen.

In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.     

Strangulated umbilical hernia including a mesenteric cyst: a rare cause of acute abdomen

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen. In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.     

Strangulated appendix epiploica in paraumbilical hernia: preoperative diagnosis and laparoscopic treatment

Appendix epiploica can occasionally cause acute abdominal pain. The usual presentations are torsion or primary epiploic appendicitis. Strangulation inside a paraumbilical hernia with acute abdominal pain is seldom reported in the literature. The authors report a case of preoperative diagnosis and laparoscopic treatment of strangulated appendix epiploica in paraumbilical hernia that presented as acute abdominal pain.     

Timely Computed Tomography Scan Diagnoses Spigelian Hernia: A Case Study

A spigelian hernia is a rare cause of acute abdominal pain and its diagnosis is often difficult to make. A CT scan of the patient demonstrated an incarcerated spigelian hernia containing small bowel which had subsequently reduced spontaneously. The patient underwent laparoscopic repair of her spigelian hernia the following day and made a fast and uneventful recovery. This case illustrates the importance of imaging a patient whilst symptomatic if the diagnosis of a spigelian hernia is entertained.     

Hand-assisted thoracoscopic repair of a Bochdalek hernia in an adult

BACKGROUND: Bochdalek hernias are congenital diaphragmatic hernias that are generally asymptomatic and often discovered incidentally. Surgical treatment is indicated once the diagnosis is made. These hernias have traditionally been repaired by open abdominal or thoracic approaches. MATERIALS AND METHODS: A healthy 24-year-old male presented with an 8-month history of shortness of breath. The patient was noted to have a postero-lateral diaphragmatic hernia, with a 4 cm defect in the left hemidiaphragm seen with computed tomography scan. He underwent hand-assisted video-assisted thoracoscopic surgery, in which the herniated omentum was reduced and the defect was repaired primarily and reinforced with Marlex mesh. The patient recovered uneventfully and was discharged home after a short hospitalization. CONCLUSION: Video-assisted thoracoscopic surgery for repair of Bochdalek hernias offers diagnostic as well as therapeutic advantages as it provides an excellent view of the surgical field, is easily executed, results in minimal surgical trauma, and has excellent cosmetic results and rapid recovery. We report a hand-assisted intracorporeal thoracoscopic repair to be a secure and satisfactory adjuvant to achieve the repair and conclude that thoracoscopic repair of the rare Bochdalek hernia is feasible.