Adult Bochdalek hernia—Clinical features, management and results of treatment

Abstract

We herein present 2 cases of adult Bochdalek hernia. Only a total of 51 such cases have been reported since 1958, and we have reviewed these cases and discussed their clinical features, operative treatment and final outcome. The majority of these patients presented as acute surgical emergencies and a lack of awareness of this condition lead to an incorrect diagnosis in 38 per cent. Intestinal obstruction with left lung signs and a non-distended abdomen in an adult patient should arouse suspicion of this condition. A plain X-ray of the chest and contrast studies of the gastrointestinal tract are necessary to confirm the diagnosis. A previous normal chest X-ray does not rule out a diaphragmatic hernia, as the defect may be plugged by the spleen or by the presence of a confining sac. The high incidence of strangulation emphasises the need for early diagnosis and prompt operative management which gives highly satisfactory results.

Adult Bochdalek Hernia

“…In adults since the diagnosis is usually missed unless there is a high index of suspicion, CT has an increasingly important role to play. Without the use of CT nearly 38% of adults are misdiagnosed as pleural effusion, empyema, lung cyst and pneumothorax [9]. Left sided Bochdalek hernias have reportedly been associated with lung hypoplasia, extralobar sequestration, mal-rotation of the mid-gut and cardiac defects, whereas, right sided hernias are generally associated with hypoplasia of the right lobe of the liver as was seen in our case [10].…”

Bochdalek Hernia in Adults: A Report of Two Cases with a Review of the Japanese Literature

“…It is also possible to perform reduction and fixation of malrotated intestine, which occurs as a frequent complication. In addition, the abdominal approach is less surgically invasive than the thoracic approach because differential lung ventilation is not required 5) . There are no established guidelines for selecting an approach, but the method that will confer the greatest benefit should be selected on a case-bycase basis.…”

“…Patients with this condition present with severe respiratory and circulatory disorders [1][2][3] . Presentation in adulthood is rare [4][5][6][7][8][9] . Reduction of the prolapsed organs and closure of the hernial orifice are important during treatment, but there are no established approaches or repair methods.…”

Congenital Diaphragmatic Hernias: Occurence in Adults

“…Erişkinlerde rastlanan sağ taraflı hernilerde birçok otör transtorasik yaklaşımı önerirken, diğerleri transperitoneal yaklaşımı önermektedir (23). Halbuki sol tarafta bile olsa, ileri derecede plevral yapışıklıklar olduğundan transtorasik yaklaşım en uygun olanıdır.…”