A Case of Adult Bochdalek Hernia with Gastric Volvulus

Abstract

A 55-year-old woman with a history of laparotomies for the treatment of sigmoid colon cancer and adhesion ileus visited our hospital with a history of vomiting. She was admitted to the hospital and was treated conservatively. However, she suffered from recurrent vomiting even after discharge from the hospital. Abdominal CT revealed a Bochdalek hernia and gastric volvulus. The stomach had escaped into the thoracic cavity and was twisted, which seemed to be the cause of the vomiting. Laparoscopic hernia repair was planned. The hernia defect was observed to be in the dorsolateral part of the left dome of the diaphragm. The stomach and omentum had herniated through the defect and were firmly adherent to the hernia sac. It was too difficult to dissect the adhesion and return these into the abdominal cavity. Therefore, the operation was changed to laparoscopic gastropexy in order to prevent the gastric volvulus from causing vomiting. The gastric anterior wall was fixed to the abdominal wall with extracorporeal ligation. Until the follow-up at six months after the operation, the patient remained asymptomatic. An adult Bochdalek hernia is a relatively rare clinical condition. Recently, an increasing number of cases of treated by total laparoscopic surgery have been reported. We encountered a case of adult Bochdalek hernia with gastric volvulus and performed laparoscopic surgery. We report this case with consideration of the literature.