Bochdalek hernia masquerading as a tension pneumothorax

Dalton, A. M.; Hodgson, Russell; Crossley, Claire

doi:10.1136/emj.2002.004697

Cited by 30 publications

(25 citation statements)

References 4 publications

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“…2005 [106]1, M, 67TraumaCT scanLaparotomy and right thoracotomyDelayed bilateral diaphragmatic rupturesDalton AM Emerg Med J. 2004 [107]1, M, 43Bochdalek herniaChest radiographThoracotomyLeft hemi thoraxStomach, transverse colon, and spleen in to the chest.Niwa T Respiration. 2003 [108]1, F, 53Bochdalek herniaChest X-rayThoracotomyLeft hemithoraxStomach and greater omentumGenc MR,Obstet Ginecol 2003 [109]1, M, 29Bochdalek hernia during pregnancyChest X-ray, CT scanAntepartum repairLeft hemithoraxBowel obructionSato M, Jpn J Thorac Cardiovasc Surg.…”

Section: Methodsmentioning

confidence: 99%

Emergency surgery due to diaphragmatic hernia: case series and review

et al. 2017

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BackgroundCongenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17–6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.MethodsFrom May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.ResultsCase 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.ConclusionOverlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.

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Section: Methodsmentioning

confidence: 99%

Emergency surgery due to diaphragmatic hernia: case series and review

et al. 2017

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“…Inappropriate intervention, such as chest tube placement, can occur in the cases of misdiagnosis [18–21]. The delay in diagnosis may also result in strangulation and death [22].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults

Saroj

Kumar

Afaque

et al. 2016

Minimally Invasive Surgery

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Background, Aims, and Objectives. Congenital diaphragmatic hernia typically presents in childhood but in adults is extremely rare entity. Surgery is indicated for symptomatic and asymptomatic patients who are fit for surgery. It can be done by laparotomy, thoracotomy, thoracoscopy, or laparoscopy. With the advent of minimal access techniques, the open surgical repair for this hernia has decreased and results are comparable with early recovery and less hospital stay. The aim of this study is to establish that laparoscopic repair of congenital diaphragmatic hernia is a safe and effective modality of surgical treatment. Materials and Methods. A retrospective study of laparoscopic diaphragmatic hernia repair done during May 2011 to Oct 2014. Total n = 13 (M/F: 11/2) cases of confirmed diaphragmatic hernia on CT scan, 4 cases Bochdalek hernia (BH), 8 cases of left eventration of the diaphragm (ED), and one case of right-sided eventration of the diaphragm (ED) were included in the study. Largest defect found on the left side was 15 × 6 cm and on the right side it was 15 × 8 cm. Stomach, small intestine, transverse colon, and omentum were contents in the hernial sac. The contents were reduced with harmonic scalpel and thin sacs were usually excised. The eventration was plicated and hernial orifices were repaired with interrupted horizontal mattress sutures buttressed by Teflon pieces. A composite mesh was fixed with nonabsorbable tackers. All patients had good postoperative recovery and went home early with normal follow-up and were followed up for 2 years. Conclusion. The laparoscopic repair is a safe and effective modality of surgical treatment for congenital diaphragmatic hernia in experienced hands.

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“…[ 3 15 ] Unfortunately, some of these patients are misdiagnosed, leading to serious consequence. [ 16 17 18 19 ] Historically these patients have been managed by laparotomy[ 1 4 5 20 21 22 ] or thoracotomy,[ 1 6 23 ] and primary repair with or without mesh reenforcement was performed. With the expansion of laparoscopic experience in various intraabdominal surgeries, there are several reports now of BH being successfully managed by a laparoscopic approach.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.

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Bochdalek hernia masquerading as a tension pneumothorax

Cited by 30 publications

References 4 publications

Emergency surgery due to diaphragmatic hernia: case series and review

Emergency surgery due to diaphragmatic hernia: case series and review

Laparoscopic Repair of Congenital Diaphragmatic Hernia in Adults

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

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