Bochdalek's hernia in adults.

Diaphragmatic hernias are rare in adults and those discovered in children are generally congenital. It is diagnosed by radiography of the chest in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms. We report a rare case of adult onset Bochdalek's hernia where the patient visited our hospital with upper abdominal pain and severe vomiting. Diagnosis was established by plain chest radiography and abdominal computed tomography. A dorsolateral defect on left side of diaphragm was corrected using a prolene mesh via an abdominal approach.

Congenital Hernias in Adults: Bochdalek Hernias

Bochdalek hernia is a congenital diaphragmatic hernia that presents rarely in adulthood. Because of the paucity of cases, no standard repair technique has been identified. Here we present two cases of robotic, thoracoscopic repair of this rare hernia defect. Two separate adult patients with right-sided abdominal pain presented to the emergency department for evaluation. Both patients were diagnosed with right-sided Bochdalek hernia and repair was undertaken with a robotic, transthoracic approach. Repair technique is described in detail, including port placement, dissection technique, and repair strategy. Advantages of the robotic, transthoracic approach are discussed in detail. A transthoracic minimally invasive approach using a robotic platform is noted to be both feasible and practical in the treatment of adult Bochdalek hernia.

INTRODUCTION: Bochdalek hernias (BH) are a type of congenital diaphragmatic hernia that mostly present in children. The diagnosis of a Bochdalek hernia in an adult patient is extremely rare accounting for an estimated 0.17% to 6% of all diaphragmatic hernias. Here we present a case of an asymptomatic Bochdalek hernia in adult patient. CASE DESCRIPTION/METHODS: Patient is a 51 year old female with a medical history of mental retardation, diabetes mellitus type 2, who was referred to our gastroenterology clinic for chronic constipation and abdominal mass. Per the patients nursing aid, on prior exam an abdominal mass was palpated on routine physical exam. On presentation to our clinic her physical exam was unremarkable. Recent complete blood count and comprehensive metabolic panel were within normal limits. Given these findings a computed tomography scan of the abdomen was done. This was done and showed no masses within the gastrointestinal tract, but was remarkable for a moderate sized left bochdalek type hernia with associated herniation of the third and fourth portions of the duodenum and the splenic flexure of the colon, without CT evidence of incarceration. On return visit, the patients nursing aid and family were notified of the findings, but refused surgical intervention for possible correction. She remained asymptomatic on follow up visits and the family continued to refuse treatment. DISCUSSION: Bochdalek hernias (BH) result are a rare congenital anomaly that results from a persistent pleuroperitoneal that occurs due to failure of the postero-lateral foramina to fuse. This allows contents of the abdomen to herniate into the thorax. Symptoms of BH depend on location. Right sided BHs may present with herniation of the liver and intestine. Left sided BHs may present with herniation of the stomach, small intestine and colon. Diagnosis of BH in adults can be challenging as symptoms are non-specific (mild abdominal pain) and up to 25% of patients are asymptomatic. Diagnosis of BHs in adults can be accomplished through imaging modalities such as computed tomography, magnetic resonance imaging, and fluoroscopy. The treatment of choice for BH is surgical repair. This should be considered in asymptomatic patients as well, given the potential for strangulation of the herniated contents.

Bochdalek hernia in adults is rare.It can be found accidentally or when it is symptomatic.It's a congenital defect of posterolateral part of the diaphragm and may contain different abdominal organs like stomach, omentum major, spleen, small or large intestine.The most commonly used diagnostic methods are CT, MRI, barium swallow test of upper GI, gastroduodenoscopy.Open surgery or mini-invasive surgical methods can restore the congenital defect.Depends on the size of the hernia, plastic reconstruction of the diaphragm can be done or using of two-component meshes.After surgery the prognosis is usually favorable.

BackgroundWhether prosthetic mesh increases infection in contaminated fields remains controversial, particularly in incarcerated hernias and adult Bochdalek hernia (BH) with gastric pathology.MethodsWe combined a PRISMA-guided systematic review of adult BH with gastric pathology (14 cases, 1981-2025) with a single-center retrospective cohort of incarcerated hernias treated laparoscopically or laparoscopy-assisted (n = 313; inguinal 177, incisional 111, diaphragmatic 10 [4 BH, 1 Morgagni], and hiatal 15). Pure open repairs were excluded. Intraoperative findings were stratified as clean, mild, or severe contamination. Primary endpoint: 3-month infectious outcomes (surgical site infection, intra-abdominal abscess, and mesh infection) comparing mesh vs non-mesh repair. A representative BH case with gastric antral perforation managed by one-stage gastric repair and mesh-reinforced diaphragmatic closure is presented.ResultsAmong clean cases receiving mesh, the 3-month infection rate was 1.5% (3/198). In mild contamination, mesh did not increase infection compared with non-mesh repair (10.0% [4/40] vs 6.7% [3/45]; RR 1.50, 95% CI 0.36-6.30; P = .702). In severe contamination, infection rates were also similar (21.4% [3/14] vs 18.8% [3/16]; RR 1.14, 95% CI 0.27-4.78; P = 1.000). The BH review showed 57.1% gastric volvulus and 42.9% perforation/necrosis; mesh was used selectively (21.4%) in staged or clean settings, and 37.5% of female cases occurred during pregnancy.ConclusionsIn this laparoscopic-dominant cohort, mesh repair after meticulous lavage was not associated with higher 3-month infection across contamination strata and appeared safe in selected severely contaminated cases. These findings support a contamination-aware, selective mesh strategy within a CT-first, laparoscopy-first pathway and warrant prospective validation, particularly for open repairs and longer follow-up.

Objectives Diaphragmatic hernias (DHs) in adults are an uncommon condition in which general characteristics and treatment strategies are poorly described. The objective of this study was to describe our institutional experience in the surgical repair of DH in adult patients. Methods A cross-sectional review was conducted on adult patients with DH who were diagnosed and surgically treated between 2012 and 2023 at the Instituto Nacional de Enfermedades Respiratorias in Mexico City. Results A total of 24 patients were included in this study, with a predominance of females (65.2%). The mean age for our study was 50 years (±4). Bochdalek hernias were the most commonly encountered (50%), followed by Morgagni hernias (25%), traumatic hernias (17%), and type IV hiatal hernias (8%). Admission (programmed vs. emergency) between surgical techniques was statistically different (p= 0.032), in addition to the development of complications between surgical techniques (p= 0.037). The mean time patients were hospitalized was 20 days (±2), with no mortality nor readmission after discharge. Conclusion Considering the outcomes of our study, both open thoracic and abdominal approaches seem feasible for treating DH in adults.

Adult presentation of congenital Bochdalek's hernia is rare. Here we report the case of a 18-year-old boy who presented to us with dyspnea, low grade fever, and cough for whom the diagnosis of congenital Bochdalek's hernia was confirmed by computed tomography (CT) scan of thorax after barium ingestion. Problems of this adult presentation because of difficulty in diagnosis, operative management, and rudimentary lung were properly and successfully dealt with in our case. We concluded that before undergoing operation in adult Bochdalek's hernia, thorough check-up is necessary as rudimentary lung may not expand resulting in ventilatory insufficiency during postoperative phase.

Bochdalek's hernia is the most common congenital malformation of the diaphragm with a defect in its posterolateral part. Its clinical manifestation in adulthood is rare. It is often an incidental finding, and its diagnosis may be challenging. A high index of suspicion is necessary, especially in cases presenting with cardiopulmonary or abdominal symptoms and an ambiguous finding on the initial chest X-ray. We present a case of an asymptomatic 50-year-old male patient with a bulky left-sided Bochdalek's hernia. Surgical treatment was indicated, and a direct suture of the defect after reduction of the herniated greater omentum, transverse colon, and tail of the pancreas was performed from the upper midline laparotomy. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. The management of adult patients with these kinds of hernias in both acute and chronic settings is discussed, and some recommendations are mentioned to minimize unnecessary pitfalls.

The adult Bochdalek hernia is one of the right-sided diaphragmatic hernias that less than 30 cases reported until now. Here, we report a 64-year-old female patient who presented with dyspnea, abdominal pain, and nausea. Primary imaging showed a right-sided diaphragmatic hernia that contained the liver and right colon. At first, the patient underwent a right posterior thoracotomy, and the diaphragmatic defect was repaired. After 2 days, abdominal peritonitis happened then a midline laparotomy was performed. Finally, it was clear that the main problem was the obstructed and perforated descending colon mass that was presented with Bockdalek hernia. Unfortunately, the patient passed away 2 days after the operation. It should be considered that an increase in intra-abdominal pressure like the presence of obstructed colon mass can cause this rare hernia and It is important to determine the reason for the presentation of the symptomatic Bochdalek hernia in adult patients.

Bochdalek hernia (BH) is a rare paediatric condition, but late diagnoses occur in adults. It occurs following incomplete posterolateral development of the diaphragm. Adult BH is asymptomatic in most cases, but it has the potential of being life-threatening. This case report is of a 35-year-old female patient who presented to us with a history of childhood abdominal discomfort leading to frequent hospitalisation. Presently, she came with complaints of increasing abdominal pain, postprandial vomiting, and a 31% weight loss over 3 months before the current admission to our facility. A preoperative diagnosis of a Type IV hiatus hernia with a possible volvulus was made with the assistance of radiology, which turned out to be left BH intraoperatively. Only the herniated stomach was laparoscopically reduced due to technical difficulties and pexied along the defect to seal it. The postoperative period was unremarkable. This case report highlights the need for maintaining a high index of suspicion and surgical preparedness for BH in patients with high-grade hiatus hernia.

Congenital diaphragmatic hernias are most common postero laterally which are called as Bochdalek hernias. They are very rare to occur in adults. Here we present a case of 50-year-old male who presented with acute respiratory distress with suspected diagnosis of hydropneumothorax which was later confirmed as left sided Bochdalek hernia. The defect was surgically repaired using a PTF mesh, after returning the contents of hernia into abdomen. This communication emphasizes the need to detect diaphragmatic hernia disguised as hydropneumothorax to avoid fatal complications.

We report a case of an acute strangulated gastric volvulus in a hernia of Bochdalek in an adult female patient that was repaired successfully via the laparoscopic approach. A left-sided diaphragmatic hernia contained a strangulated but viable gastric volvulus and a noncompromised colon. The contents of the hernia were reduced, and the 4-cm congenital diaphragmatic defect was primarily repaired with nonabsorbable sutures. The patient was discharged on the second postoperative day and remained symptom-free at 7 months. Unlike the very few previous reports of elective laparoscopic repair of uncomplicated Bochdalek hernias, this appears to be the first report of an urgent laparoscopic repair of a complicated hernia of this type.

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Bochdalek hernia (BH) is a rare congenital diaphragmatic defect in adults, often presenting with nonspecific symptoms and posing challenges in diagnosis and treatment. Traditional open surgery is associated with significant trauma, while minimally invasive techniques have gained popularity. This multicenter retrospective cohort study aimed to evaluate the feasibility and short-term efficacy of the retroperitoneal totally endoscopic prosthetic (R-TEP) repair technique for adult BHs. A retrospective review was conducted on ten adult patients with BHs who underwent R-TEP repair from February 2022 to December 2023 across four tertiary hospitals. Patient demographics, hernia characteristics, operative details, perioperative complications, and follow-up outcomes were analyzed. Continuous variables are presented as median (range). The median age of the patients was 53.50years (range: 23-66), with a median body mass index (BMI) of 25.01kg/m2 (range: 22.31-27.94). The majority of patients (80%) presented with left-sided hernias. The median defect area was 13.50 cm2 (range: 6-42), with a median mesh area of 145.00 cm2 (range: 130-170). The median operative time was 117.50min (range: 90-180), with minimal intraoperative blood loss. One patient with a larger defect (42 cm2) required conversion to laparoscopic intraperitoneal onlay mesh (IPOM) repair due to excessive defect size, limited operative field, and peritoneal injury. All other operations were successfully performed without serious intraoperative complications. The median postoperative hospital stay was 2.50days (range: 2-4). No major postoperative complications occurred, and no recurrence was observed during a median follow-up period of 29.5months (range: 20-42). Compared with baseline, Carolina comfort scale (CCS) scores for pain, mesh sensation, and movement limitation all improved significantly at the 6-month follow-up. The R-TEP repair technique for adult BHs is safe, effective, and reproducible. It offers a minimally invasive approach with favorable outcomes, including reduced postoperative pain, shorter hospital stays, and a low recurrence rate. This technique is a valuable addition to the surgical management of adult BHs and merits validation in larger prospective studies.