Right-sided Bochdalek hernia containing retroperitoneal fat in the elderly: report of a case

Abstract

Background Most cases of Bochdalek hernias are diagnosed during the neonatal period and arise on the left side. We report a rare case of a right-sided Bochdalek hernia in an elderly patient. Case presentation A 72-year-old man presented with chest tightness and nausea. He had no history of thoracic and abdominal trauma. Preoperative CT scan showed a well-circumscribed mass in the right thoracic cavity of 28-cm diameter compressing the right lower lobe. The mass was mostly fat component and seemed to connect with retroperitoneal fat. We made some diagnoses: lipoma, liposarcoma, and diaphragmatic hernia. Surgical resection was performed by thoracotomy so as to resect the mass and repair the defect of the diaphragm. The mass seemed to be retroperitoneal fat which escaped from the hernia orifice. The neck of the mass was separated by a vessel-sealing device immediately above the hernia orifice. The defect of the diaphragm was repaired by direct suturing after completion of resection. Microscopic pathologic examination showed that the mass was maturated fat tissue. Four months postoperatively, there was no evidence of recurrence of the hernia. Conclusions The diagnosis of an adult Bochdalek hernia is often difficult, so it is important to consider the examination carefully and to determine the better surgical procedure.

A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway

“…The suture type was mostly non-absorbable ( n = 13, 65%) followed by absorbable sutures ( n = 4, 20%). Three cases (15%) did not describe the type of suture [ 31 , 32 , 36 ].…”

Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan

“…The 94 remaining case studies, published between 1999 and 2019, matched our inclusion criteria for this analysis. We accessed and analyzed 96 case reports of adult BH including the present case (Table 1) [10][11][12][13][14][15].…”

“…Surgical reduction of the prolapsed organs and the closure of the hernia orifice is required. Although recently published studies have described the efficacy of thoracoscopic and/or laparoscopic repair for BH in adults, there are currently no established optimal approaches or methods [ 2 , 4 , 10 – 15 ]. Herein, we describe our experience of adult BH in detail and review in light of surgical options from the available literature on Japanese cases.…”

Surgical treatment of Bochodalek hernia incarcerated into the extra-pleural space: A rare case report

“…Almost all BHs occur in the neonatal period; however, 5% occurs in adults [ 1 ]. BHs in adults are likely caused by increased intraabdominal pressure as a result of obesity [ 5 ], trauma [ 6 ] or pregnancy [ 7 ]. Our patient’s weight had increased in recent years, likely causing his BH.…”

“…We therefore consider that surgical repair is indicated for both asymptomatic progressive BH and symptomatic BH. Most asymptomatic BHs contains only retroperitoneal fatty tissue [ 12 , 5 ]. However, high-grade renal obstruction reportedly occurs consequent to herniation of retroperitoneal fatty tissue in some cases [ 13 , 14 ].…”