Figure - available from: Case Reports in Surgery
This content is subject to copyright. Terms and conditions apply.
Source publication
Introduction
Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016). Difficulty and delay in diagnosis may lead to life-threatening complications.
Case Report
We report a case of Bochdale...
Citations
... The major maternal complications are compression atelectasis of the lungs, respiratory failure, and strangulation of the herniated internal organs. The risk of maternal mortality increases with the development of gastrointestinal obstruction, possibly due to respiratory distress, bowel strangulation and perforation, fetal hypoxia, and acidosis [13]. In our patient, respiratory compromise and acute gastric volvulus led to rapid deterioration despite resuscitation, with the development of severe alkalosis and fetal distress. ...
... Chest radiographs, ultrasound, CT, and magnetic resonance imaging (MRI) can be used for the diagnosis of Bochdalek hernias [2]. Chest radiographs can be used safely during pregnancy with a sensitivity of 70% [13]. Chest radiographical features include displacement of the mediastinum, air bubbles above the diaphragm level, and an opacified hemithorax. ...
Acute gastric volvulus is a surgical emergency and is known to occur secondary to diaphragmatic hernia and eventration. Adult presentation of congenital diaphragmatic hernia is rare, with an estimated incidence of around 0.17%, and pregnancy may predispose to the development of symptoms due to increased intra-abdominal pressure. Pregnancy complicated by diaphragmatic hernia is associated with a high risk of maternal and fetal mortality, necessitating timely diagnosis and treatment. We present the case of a 23-year-old female presenting with a symptomatic left Bochdalek hernia complicated by organo-axial gastric volvulus during her second trimester (27 weeks). Emergency laparotomy was performed, with Caesarean section, reduction of gastric volvulus, and mesh repair of the left posterolateral defect.
... 5 The diagnosis of Bochdalek hernia during pregnancy is quite rare, with only 44 cases reported up to 2016. 6 Its infrequency leads to its unsuspected occurrence, delaying diagnosis, and facilitating the appearance of complications, with a mortality of up to 32% when intestinal strangulation occurs. 1 These are usually previously asymptomatic patients who, with the increased abdominal pressure associated with pregnancy, develop symptoms such as pain, gastrointestinal symptoms, or dyspnea. 1 Despite the high maternal-perinatal morbidity associated with this condition, some publications have supported surgical correction of the lesion during gestation, subsequently allowing the evolution of the pregnancy. 6 The patient has given her consent to publish her clinical information and figures in this journal. ...
... 6 Its infrequency leads to its unsuspected occurrence, delaying diagnosis, and facilitating the appearance of complications, with a mortality of up to 32% when intestinal strangulation occurs. 1 These are usually previously asymptomatic patients who, with the increased abdominal pressure associated with pregnancy, develop symptoms such as pain, gastrointestinal symptoms, or dyspnea. 1 Despite the high maternal-perinatal morbidity associated with this condition, some publications have supported surgical correction of the lesion during gestation, subsequently allowing the evolution of the pregnancy. 6 The patient has given her consent to publish her clinical information and figures in this journal. ...
... 7 The recommended approach is immediate surgical management, including maternal steroids after the 24 th week of gestation. 6,8 After surgery, the most usual course is favorable, with no further complications. ...
Congenital diaphragmatic hernia consists of a defect in the embryonic development of the diaphragm that allows the passage of the abdominal viscera into the thoracic cavity, its diagnosis during pregnancy is quite rare. We present the case of a 31-year-old woman, with 23 weeks of gestation, who consulted for epigastric pain, nausea, and repetitive emetic episodes, without improvement with the medication provided. Due to the intense abdominal pain, a computed tomography of the abdomen and thorax was performed where the 28 mm defect was found at the left diaphragmatic level with protrusion of the gastric fundus to the thoracic cavity. She was taken to surgical management by laparoscopy with abdominal and thoracic approach, with a successful result and without maternal perinatal complications. Although the integrity of the diaphragmatic suture could be feared in relation to the increase in intraabdominal pressure due to uterine growth, the evolution of our patient and previous reports show that postoperative complications are not frequent. Successful vaginal delivery has even been described in some reports. Diaphragmatic hernias diagnosed during pregnancy are quite rare. We suggest that the optimal management of them during pregnancy is immediate surgical correction in case of persistent symptoms, more studies are needed to establish firm recommendations on the management of this pathology.
... Chest radiographs, ultrasonography (USG) [25], and magnetic resonance imaging (MRI) have reliable diagnostic significance for evaluating a suspected BH regardless of pregnancy status [21,32,33,38,39,42]. ...
Background:
Since the first report of a diaphragmatic hernia from Ambroise Paré's necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early.
Data sources and study selection:
A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups' presence due to their rarity.
Results:
The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases.
Conclusion:
Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.
A diaphragmatic hernia is a rare condition during pregnancy, but the symptomatic form carries high maternal and especially fetal mortality. Nonspecific symptoms are commonly attributed to other diseases, especially because clinicians are reluctant to use plain chest X-ray, which is often diagnostic. The use of thoracic sonography and thoracic MRI add to an earlier and more accurate diagnosis. In most cases, present immediately after labor and abdominal or thoracic CT can be performed with high diagnostic accuracy. For a symptomatic patient, treatment is surgical, mostly at the time of presentation. A treatment algorithm is less straightforward for asymptomatic patients detected during pregnancy. Some recommend surgical treatment to prevent complications during labor when increased intra-abdominal pressure occurs, while others operate when symptoms develop. The type of delivery is also not solved completely. Some recommend Cesarean section at 34 weeks with simultaneous diaphragmatic hernia repair. Others claim that vaginal delivery is safe with laparoscopic diaphragmatic hernia repair postpartum.
