Acute hernia of Bochdalek during pregnancy Hyperemesis for the first time in a third pregnancy?

Toorians, Arno W. F. T.; Drost-Driessen, Margaret A.; Snellen, J.P.; Smeets, Rene W. M. C.

doi:10.3109/00016349209041449

Cited by 16 publications

(6 citation statements)

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supporting

confidence: 80%

“…They were found to be more frequent in women than in men (17:5) and Mullins results show that right-sided Bochdalek hernias are more common than we believed up to now in asymptomatic patients (incidental hernias). The left-sided presentation in our patient agrees with the majority of symptomatic cases reported, accounting for 80-90% of all cases [4,5].When this kind of hernias appear in adult, it is believed that an anatomical failure previously existed, and the hernia is possibly triggered by a trauma or increased abdominal pressure like pregnancy and delivery. In fact, the number of adults with asymptomatic congenital diaphragmatic hernia remains unknown and in women, it may not debut until pregnancy [6].…”

supporting

confidence: 77%

“…Diagnosis in pregnant patients is quite difficult because its symptoms are similar to those of some common pathology during pregnancy, so it is essential to take into account these rare disorders. Heartburn, nausea and vomiting are extensive during pregnancy: the failure of usual treatments to improve the symptoms especially in women with advanced pregnancy should guide the physician to more severe gastrointestinal problems [4]. Auscultation of bowel sounds on chest examination is highly indicative of a diaphragmatic hernia.…”

Section: Discussionmentioning

confidence: 99%

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Bochdalek Diaphragmatic Hernia Complicating Pregnancy in the third Trimester: Case Report

Hernández-Aragon¹

2015

Obstet Gynecol Cases Rev

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birth or in the immediate neonatal period. Bochdalek hernias are the most prevalent CDH in neonates: 1 in 2200 births [2]. Clinical apparition for the first time in the adult period is rare and pregnancies complicated by Bochdalek hernia are even more unusual (to our knowledge 44 cases, including this one, have been reported in the literature since 1928).However, we don´t know the true prevalence of this kind of hernia in adults. Mullins et al published incidence in adults of 0.17%, based on the 13 138 abdominal computerized tomography (CT) scans reviewed [3]. In their review, 68% of Bochdalek hernias were on the right side, 18% were on the left, and 14% were bilateral. They were found to be more frequent in women than in men (17:5) and Mullins results show that right-sided Bochdalek hernias are more common than we believed up to now in asymptomatic patients (incidental hernias). The left-sided presentation in our patient agrees with the majority of symptomatic cases reported, accounting for 80-90% of all cases [4,5].When this kind of hernias appear in adult, it is believed that an anatomical failure previously existed, and the hernia is possibly triggered by a trauma or increased abdominal pressure like pregnancy and delivery. In fact, the number of adults with asymptomatic congenital diaphragmatic hernia remains unknown and in women, it may not debut until pregnancy [6]. Symptomatic diaphragmatic hernias during pregnancy, labor and delivery are rare, but the potential consequences are significant. Because of their symptoms simulate other conditions more common in pregnancy, diagnosis and treatment may be delayed, resulting in excessive mortality among these patients [7].We describe an unusual case of a pregnant patient diagnosed with left-sided Bochdalek hernia in her third trimester that we consider interest publication for obstetrical practice. Case PresentationA 32-year-old primiparous woman was admitted to a local hospital (29 weeks´ gestation) because of her gastrointestinal clinic: nausea, vomiting and epigastric pain for three days. She presented normal depositions and no dyspnea. The patient had no medical history of interest. On physical examination, she was afebrile with Abstract Background: Maternal congenital diaphragmatic hernia complicating pregnancy is an unusual but severe pathology. We only noticed 43 reports on this subject in English between 1959 and 2014.

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supporting

confidence: 80%

supporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Bochdalek Diaphragmatic Hernia Complicating Pregnancy in the third Trimester: Case Report

Hernández-Aragon¹

2015

Obstet Gynecol Cases Rev

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“…BH, Bochdalek hernia; NA, not available; VD, vaginal delivery; C/S, cesarean section. a [ 7 , 16 , 23 , 24 , 35 , 37 ]; b [ 10 , 31 , 32 , 36 , 27 ]; c [ 29 ]; d [ 42 ]; e [ 9 ]; f [ 30 ]; g [ 11 , 15 ]; h [ 21 , 39 ]; i [ 23 , 28 , 25 , 44 ]; j [ 11 , 15 , 30 ]; k [ 33 ]; l [ 4 , 12 , 17 , 19 , 22 ]; m [ 4 , 5 , 18 , 26 , 34 , 41 , 45 ]; n [ 14 ]; o [ 20 ]; p [ 13 ].…”

Section: Figurementioning

confidence: 99%

Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports

et al. 2021

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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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“…Maternal diaphragmatic hernia complicating pregnancy is a rare but potentially life‐threatening condition. In 1913, Muller described a fatal case of a strangulated diaphragmatic hernia presenting in the puerperium 1 and at least 31 further cases involving pregnancy have subsequently been described 2–30 . Although hiatus hernias are a relatively common cause of minor complaints in pregnancy, the rarer congenital or traumatic diaphragmatic defects may predispose to incarceration and strangulation of abdominal viscera within the thorax as the uterus enlarges.…”

Section: Introductionmentioning

confidence: 99%