Laparoscopic reduction of an acute gastric volvulus and repair of a hernia of Bochdalek

We report a case of an acute strangulated gastric volvulus in a hernia of Bochdalek in an adult female patient that was repaired successfully via the laparoscopic approach. A left-sided diaphragmatic hernia contained a strangulated but viable gastric volvulus and a noncompromised colon. The contents of the hernia were reduced, and the 4-cm congenital diaphragmatic defect was primarily repaired with nonabsorbable sutures. The patient was discharged on the second postoperative day and remained symptom-free at 7 months. Unlike the very few previous reports of elective laparoscopic repair of uncomplicated Bochdalek hernias, this appears to be the first report of an urgent laparoscopic repair of a complicated hernia of this type.     

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.     

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.     

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.     

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.     

Urgent surgical repair of symptomatic Bochdalek hernia containing an intrathoracic kidney

Bochdalek hernias rarely contain an intrathoracic kidney, and there are few reports of their operative repair. A woman presented with progressive dyspnoea limiting her quality of life. Imaging showed a Bochdalek hernia containing omentum, large bowel and the left kidney. The woman was unexpectedly admitted to the intensive care unit with respiratory failure secondary to gallstone pancreatitis whilst awaiting elective repair of her hernia. Surgical repair of the hernia was performed via laparotomy with cholecystectomy to treat both problems. The woman recovered well and is independently mobile without any exertional dyspnoea.     

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.     

Congenital Bochdalek hernia in the adult: repair by a primary thoracotomy incision

Background

Congenital Bochdalek hernia may present in the adult and requires repair. There is still some controversy regarding the optimal approach for repair.

Material and methods

We present 6 adult cases with Bochdalek hernia. All 6 underwent a primary thoracic repair.

Results

The exposure and access was adequate in all cases. Vascular adhesions with the pleura which were easily dealt with were seen in all. No additional abdominal incision was required in 2 cases, and was a mini-laparotomy in 2 cases and a mid line laparotomy in 2.

Conclusions

Adult Bochdalek hernia in the adult can be repaired with a primary thoracic incision.     

Laparoscopic repair of congenital diaphragmatic hernias

Bochdalek and Morgagni hernias are the least common congenital diaphragmatic hernias, with the prevalence of Bochdalek hernia being 1/2200 births and the prevalence of Morgagni hernia being 1/1 million births. Although they are usually asymptomatic, congenital diaphragmatic hernias, especially Bochdalek and Morgagni hernias, are diagnosed in early childhood. In adulthood, they are diagnosed incidentally or when they become symptomatic. The repair of congenital diaphragmatic hernia is indicated in all children and symptomatic adults. We present three cases of congenital diaphragmatic hernia, two Morgagni and one Bochdalek hernias, repaired laparoscopically. We describe the operational methods. The results of the operations were satisfactory, with cure defined with radiological images after 1 month. We propose the use of laparoscopy in the repair procedure because it is a safe and effective method. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization stay.     

Laparoscopic repair of late-presenting Bochdalek hernia in 2 infants

Laparoscopic repair was performed on 2 infants with late-presenting Bochdalek hernia. Intraoperatively, the entire small intestine was herniated in 1 case and the stomach, small intestine, and part of the colon and spleen were herniated in the other case. Laparoscopic repair of Bochdalek hernia was successfully completed in both the cases. On the basis of our experience, 4 points seem important in laparoscopic surgery for Bochdalek hernia: (1) avoiding damage to the spleen while reducing organs back into the abdominal cavity; (2) ensuring visualization of diaphragmatic defect after reducing the spleen and intestinal tract; (3) ensuring sufficient width to suture the dorsal side of the diaphragm; and (4) identifying intestinal malrotation. We believe that the fourth point represents an advantage of a laparoscopic approach, which seems superior to the thoracoscopic approach and could represent a useful therapy for Bochdalek hernia in infants and older patients.     

Laparoscopic mesh repair of a diaphragmatic hernia of Bochdalek

The advent of minimally invasive surgery has facilitated the laparoscopic repair of diaphragmatic hernias. One of the difficulties associated with long-standing Bochdalek or Morgagni hernias is that the herniated contents are often quite adherent to the diaphragmatic defect and require considerable dissection before the reduction of herniated organs. Ultrasonic dissection using a harmonic coagulation shears allowed safe, bloodless division of the long-standing adhesions, which is essential for atraumatic reduction of herniated thoracic contents. We herein report the successful laparoscopic mesh repair of a Bochdalek hernia in a 67-year-old man.     

Bochdalek diaphragmatic hernia presenting with acute gastric dilatation

Congenital diaphragmatic hernia through the foramen of Bochdalek may present after infancy. A 21/2-year-old Malay girl presented with acute respiratory distress. Chest examination showed reduced chest expansion and decreased breath sounds on the left side. Chest radiograph showed a large "cyst" in the left chest, which was thought to be a lung cyst under tension. Tube thoracostomy resulted in clinical improvement. Results of a barium study showed that the cyst perforated by the thoracostomy tube was the stomach, which had herniated through a Bochdalek diaphragmatic defect. Surgical repair of the diaphragmatic defect and closure of the perforated stomach was performed successfully. Congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in young children. Nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected.     

新生儿及婴幼儿胸腹裂孔疝诊治的临床特点

目的 总结先天性胸腹裂孔疝的临床特点及诊治经验，以提高治愈率及成活患儿的生活质量。方法 回顾分析1983年8月～2004年6月诊治的25例先天性胸腹裂孔疝。1998年4月以前诊治8例，其中新生儿5例，婴幼儿3例；1998年4月-2004年6月诊治17例，其中新生儿10例，婴幼儿7例。左侧22例，右侧3例。行手术治疗24例，另1例未及手术即死亡。结果 1998年4月以前诊治的8例，术后7例成活，并获随访1年3个月～11年，无任何呼吸道症状，生长发育良好；死亡1例系早产儿，入院时出现紫绀、呼吸衰竭，尸检发现其肺体积甚小。1998年4月～2004年6月诊治的17例，术后15例成活，2例新生儿死于呼吸衰竭。结论 新生儿患儿呼吸困难出现越早，病情越严重；婴幼儿病情相对稳定。及时规范的处理可提高治愈率，延期手术应视患儿具体情况而定。     

Bochdalek diaphragmatic hernia in the elderly: a case report]

We successfully treated surgically an elderly patient, a 80-year-old woman, with Bochdalek diaphragmatic hernia. She had intermittent episodes of intestinal obstruction. A preoperative chest roentgenograph revealed a loop of gas-filled bowel in the left chest and elevation of the left diaphragm. CT scanning of the thorax revealed the bowels filled with gastrografin in the left thoracic cavity. She was treated surgically, through transabdominal and then transthoracic approaches. The herniated large bowel was reduced from the thoracic cavity and the hernial sac was excised. The posterolateral defect of the diaphragm, 5 x 6 cm in size was closed with interrupted mattress sutures. The patient has been well without any symptoms 6 months after the surgery. Bochdalek diaphragmatic hernia is the most common problem in infants with risky respiratory distress and high mortality, however it is preferable to carry out surgical treatment for adult patients because of good postoperative results. As a surgical route in the management of Bochdalek diaphragmatic hernia in adults, a transthoracic approach is preferable since it provides easy separation and reduction of herniated bowels from the thoracic cavity and easy closure of the diaphragmatic defect, furthermore there are no other serious gastrointestinal complications which are required specific repair.     

Incarcerated Bochdalek hernia in an adult

Congenital posterolateral diaphragmatic hernia (Bochdalek hernia) usually presents in the neonatal period with life-threatening cardiorespiratory distress. However, on rare occasion, Bochdalek hernias may remain silent until adulthood and present as a surgical emergency. This report describes a young man with acute abdominal pain and incarceration of the colon. Clinicians should keep this rare diagnosis in mind when evaluating an adult patient with acute abdominal pain for early diagnosis and improved outcome.     

Right-sided Bochdalek's hernia in an adult

Bochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood, but may rarely be detected in adults. The treatment of choice is operative repair due to the risk of visceral herniation and strangulation.     

An 81-year-old gentleman with symptomatic Bochdalek hernia

An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia.     

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     

Laparoscopic retroperitoneal repair of a right-sided Bochdalek hernia

Bochdalek hernias are rare congenital diaphragmatic defects. We report a case of a 50-year-old male with chronic shortness of breath who was diagnosed with a right-sided Bochdalek hernia. This hernia was repaired using a laparoscopic retroperitoneal approach.     

Robotic repair of a Bochdalek congenital diaphragmatic hernia in a small neonate: robotic advantages and limitations

Minimally invasive repair for a Bochdalek congenital diaphragmatic hernia has been performed over the last few years with mixed results. Although the anomaly has been approached from both the abdomen and the chest, the defect can be difficult to close as the posterolateral region may be difficult to reach with precise suturing using standard rigid laparoscopic instruments. The articulating instruments of robotic surgery offer a substantial improvement in degrees of freedom and may help over come these obstacles. However, other limitations including instrument length in relation to patient size need to be accounted for when planning a robotic procedure in small children. We present a robotic repair of a foramen of Bochdalek congenital diaphragmatic in a 2.2 kg neonate using and abdominal approach with the Da Vinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA).