Massive Bochdalek diaphragmatic hernia in adult with hypoplastic lung

Abstract

Bochdalek diaphragmatic hernia is generally congenital and rarely diagnosed incidentally in adults. A 21-year-old man presented with a diaphragmatic hernia suspected during routine examination. Chest radiography showed the colon and small intestine herniating into the left hemithorax and the ileocecal appendix in the superior thoracic apertura. We performed a thoracoabdominal incision and the stomach, omentum, colon, and small intestine were retracted back into the abdomen. The diaphragm was repaired with Prolene mesh following adhesiolysis. Two months later, there was no recurrence but no lung expansion. The space was filled with effusion, but the patient had no complaints.

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

“…[ 61 ] Historically these patients were managed either by an open transabdominal or by a transthoracic approach. However, with the expansion of laparoscopic[ 4 7 8 9 10 12 24 25 26 27 28 ] and thoracoscopic[ 74 75 76 77 78 79 80 81 82 83 84 85 ] expertise and advances in instruments, the minimally invasive approach has emerged as an attractive option. There are, however, several areas of debate and these include the following:…”

“…The approach to repair of BH depends on the presentation (emergency or elective), size and side of the defect, and the presence of complications. [ 4 5 8 10 76 77 78 79 80 ] For emergent cases, laparotomy is the favored approach, using either a midline or subcostal, or in difficult cases a thoracoabdominal, incision. [ 4 7 8 41 79 ] This achieves better visualization of diaphragm on the left side and on the right side; the same is achieved following the mobilization of the right lobe of the liver.…”