Emergency, anaesthetic and intensive care management of a case of eventration of diaphragm, Bochdalek hernia and an intra-thoracic gastric rupture with gastric gangrene

Adult onset congenital diaphragmatic hernia (CDH) is uncommon but not rare. Morgagni hernia is a rare variant of CDH. The defect tends to be small and patients may remain asymptomatic and diagnosed incidentally. When these patients become symptomatic, they usually present with gastrointestinal and cardiorespiratory symptoms or sometimes as an emergency due to obstruction or strangulation of herniated viscera. Chest radiograph, computed tomography scan, and magnetic resonance imaging are the imaging modalities used for diagnosis of CDH. Cardiopulmonary compromise due to mass effect of hernial contents on lungs, heart and great vessels, and obstruction or strangulation of herniated viscera poses the special challenge before anesthesiologists. Our patient was diagnosed to have Morgagni hernia, at the age of 72 years and underwent laparotomy for the same. This case highlights the key feature of the successful anesthetic management of adult onset CDH.

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“…When chest radiographs are indeterminate, spiral CT and magnetic imaging must be considered for evaluating diaphragm. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have described the safe use of single lumen endotracheal tube instead DLT during emergency situations, provided lung protective strategy should be used, although this should not be the standard practice. [ 5 8 ]…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of Morgagni hernia repair in an elderly woman

et al. 2015

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Bochdalek Hernia with Gastric Necrosis in a 54-Year-Old Man, Case Report and Review of the Literature

Andrade¹

2016

MOJCR

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Atraumatic Massive Left-sided Bochdalek Hernia in Adulthood: A Case Report

Ismail,

Zainy,

Adnan

2024

Bali J Anesthesiol

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Bochdalek hernia, a rare congenital anomaly of the diaphragm, typically manifests in the pediatric population but can also occur in adults. In the adult population, it presents unique challenges in airway management due to the potential displacement of abdominal organs into the thoracic cavity, resulting in compromised respiratory function. We report the case of a 61-year-old male with a massive left-sided Bochdalek hernia, presenting with upper abdominal pain. Imaging revealed an 8.7-cm defect in the left diaphragm, resulting in herniation of the abdominal viscera into the thoracic cavity, causing a mediastinal and tracheal shift. Emergency surgical repair was conducted, requiring careful airway management, including the use of a bronchial blocker (BB) for lung isolation to safely reduce the herniated organs into the abdominal sac and repair the diaphragmatic defect. Though rare, the incidence of Bochdalek hernia in adults necessitates specific considerations for airway management due to its anatomical complexities and potential for respiratory function compromise. Successful management highlights the need for thorough preoperative planning and inter-team communication in such complex scenarios. This case demonstrates the challenges and critical considerations in managing adult Bochdalek hernia, emphasizing the importance of tailored airway management strategies and coordinated care to optimize patient outcomes in such rare disease cases.

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Emergency, anaesthetic and intensive care management of a case of eventration of diaphragm, Bochdalek hernia and an intra-thoracic gastric rupture with gastric gangrene

Cited by 3 publications

References 14 publications

Anesthetic management of Morgagni hernia repair in an elderly woman

Anesthetic management of Morgagni hernia repair in an elderly woman

Bochdalek Hernia with Gastric Necrosis in a 54-Year-Old Man, Case Report and Review of the Literature

Atraumatic Massive Left-sided Bochdalek Hernia in Adulthood: A Case Report

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