Figure 3 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Source publication
Bochdalek hernias are rare in adults. We report 2 cases of Bochdalek hernia with bowel obstruction. The first case was a 74-year-old male patient who suffered from abdominal pain and chest tightness for 1 day. Chest radiography indicated a mass-like lesion above the left diaphragm. The pain could not be relieved by nasogastric tube decompression fo...
Context in source publication
Similar publications
A diaphragmatic hernia is a protrusion of the abdominal contents into the negative pressure thoracic cavity through a congenital or acquired diaphragmatic defect. Generally, acquired diaphragmatic hernia is a rare, life-threatening condition that usually follows blunt/penetrating trauma or an iatrogenic cause, resulting in the diaphragmatic rupture...
Congenital diaphragmatic hernia is a developmental defect of the diaphragm that allows herniation of abdominal contents into the thoracic cavity. It is usually diagnosed in the neonatal period. Late presenting cases are uncommon and difficult to diagnose, due to their rarity and diversity of semiology, with clinical presentation overlapping with ot...
Background:
Bochdalek hernia is a congenital diaphragmatic hernia, and adult cases are rare, with a reported frequency of 0.17%-6% among all diaphragmatic hernias.
Presentation of case:
A 78-year-old man was referred to our hospital with a sudden onset of whole abdominal pain after playing with a blow gun. Chest radiography and computed tomograp...
A 70-year-old woman presented to the emergency department with symptoms of a lower respiratory infection. A chest x-ray showed enlargement of the mediastinal space. The patient was admitted with a respiratory tract infection and started on antibiotic treatment. A computed tomography (CT) scan of the thorax revealed a large diaphragmatic hernia with...
Bochdalek hernia occurs from a congenital defect of the diaphragm, allowing the passage of abdominal structures into the thoracic cavity, limiting lung expansion and ventilatory function. Bochdalek hernia is common in neonates but rarely occur in adults; there are only 4 documented cases in the elderly population. We present a case of an 88-year-ol...
Citations
... Acquired diaphragmatic hernias comprise less than 50% of diaphragmatic injuries and are mostly traumatic [7]. Patients often give history of a blunt trauma or road traffic accident [8] and remain undiagnosed in up to 33% cases during the immediate post-traumatic period [9]. The reason behind this delay in diagnosis is often poor clinical suspicion along with the varied clinical presentation. ...
... A simple chest X-ray (CXR) can give a clue of transposition of abdominal contents in the mediastinum. Computed tomography scan further provides diagnosis of diaphragmatic injury and herniation with a sensitivity and specificity of 71% and 100% respectively [9]. In both of our cases the strongest degree of clinical suspicion arose when upper GI endoscopic procedure proved to be troublesome without any apparent cause of difficulty. ...
Introduction: A diaphragmatic hernia is a condition characterized by herniation of the abdominal content(s) via a defect in the diaphragm. It may be congenital or may be preceded by a history of trauma. Case Series: Here we report two cases whose diaphragmatic hernias were detected on evaluation of a difficult gastroscopy. Both cases were those of young males who presented with non-specific gastrointestinal (GI) symptoms which warranted further evaluation with upper GI endoscopy and imaging. The first patient had a history of abdominal trauma during a road traffic accident. When scope negotiation proved to be difficult, they were both investigated and found to have displacement of the stomach within the mediastinum. Surgery was done followed by uneventful recovery in both patients. Conclusion: Diaphragmatic hernias do not always present in the background of typical settings and may be asymptomatic in many cases. However when any undue resistance is faced during endoscope negotiation, a high degree of clinical suspicion should be kept for any anatomical aberration—either congenital or acquired. This may ensure early detection and prevent life-threatening acute conditions as an acute gastric volvulus.
... Diagnosis is often delayed if patient is asymptomatic after diaphragmatic injury. 1 Symptoms are variable such as difficulty in breathing, absence of breadth sounds in chest, pain abdomen and obstruction of bowel. 5 Our patient did not give history of trauma or surgery in the past. So most probably cause of diaphragmatic hernia was either trivial trauma or a small congenital defect which became extensive. ...
Spontaneous acquired diaphragmatic hernia is a rare finding, which occurs in the absence of any history of surgery or trauma. We report a rare case of incidentally diagnosed spontaneous diaphragmatic hernia in an elderly female who came in emergency department for pathological intertrochanteric fracture. She had left ventricular ejection fraction 35% and mild mitral regurgitation. Surgical repair of diaphragmatic hernia was planned. But she developed respiratory distress and was shifted to intensive care unit for stabilization. We are mentioning the successful management of this elderly female with diaphragmatic hernia. This case explains the importance of physical examination and various considerations in patients with diaphragmatic hernia and low ejection fraction.
... Assessment of blood supply with a harmless substance at the time of operation is an undeniable weapon in the surgeon's arsenal in order to provide the patient with the optimal treatment without inadvertently assuming false blood supply of the herniated organs. The phenomenon of ischemia in such hernias has been reported and further anatomical dissections were required [10,14,15]. Macroscopic alteration of blood supply could be absent at time of operation, so intraoperative ICG green application readily evaluates such cases. ...
Bochdalek hernias are usually diagnosed in newborns. However, they can occur in adults. Few reports exist regarding robotic repair of such hernias. We present a case of a female patient with symptomatic Bochdalek hernia, including the spleen. Patient was successfully treated by robotic-assisted surgical mesh with the use of indocyanine green (ICG). An 80-year-old female patient presented with dyspnea, angina and intermittent abdominal pain. She had loss of appetite and 15-kg weight loss within 3 months. Past medical history was unremarkable. Imaging revealed a left Bochdalek hernia. The patient underwent robotic-assisted surgery; hernia contents included stomach, parts of colon, omentum and remarkably the spleen. Sac was dissected free. Patency of organs was assessed with ICG. Diaphragmatic defect was repaired with mesh. Bochdalek hernias should be surgically repaired. Minimally invasive therapy is safe and effective. Intraoperative ICG use can provide excellent results with favorable clinical outcomes.
... Bohdalekova hernija je retka kod odraslih i javlja se sa učestalošću od 0,17 do 6% svih dijafragmalnih hernija (3,6). Posterolateralna Bohdalekova hernija je najčešći tip urođene dijafragmalne hernije (95%). ...
Cilj rada je da se prikaže redak slučaj Bohdalekove
hernije kod odraslog pacijenta i da se naglase značaj
kliničke sumnje i značajna uloga imidžing tehnika u
postavljanju tačne dijagnoze ove abnormalnosti.
Bohdalekova hernija predstavlja kongenitalni defekt
lokalizovan na posterolateralnom zidu dijafragme, kroz koji
organi trbušne duplje prolaze u grudni koš. Primarno se
dijagnostikuje u neonatalnom i postneonatalnom periodu,
dok je kod odraslih veoma retka. Autori prikazuju slučaj
Bohdalekove hernije u odraslom dobu sa simptomima koji
potiču od gastrointestinalnog i respiratornog trakta.
Dijagnoza je potvrđena kompjuterizovanom tomografijom
grudnog koša. Predstavljen je redak slučaj levostrane
Bohdalekove hernije otkriven u kasnijoj životnoj dobi koja je
hirurški tretirana sa uspehom.
Ključne reči: kile, dijafragmalne, kongenitalne; odrasla
osoba; tomografija, X-zracima kompjuterizovana
... Mortality has been reported in approximately 25-60% of patients with ADH due to lack of timely surgical intervention. 6,7 The mainstay of surgical management is reduction of herniated contents and diaphragmatic repair. Diagnosis of diaphragmatic injuries is challenging and requires a high index of clinical suspicion. ...
... Mortality has been reported in approximately 25-60% of patients with ADH due to lack of timely surgical intervention. 6,7 The mainstay of surgical management is reduction of herniated contents and diaphragmatic repair. ...
Acquired diaphragmatic hernias (ADH) are uncommon following penetrating thoraco-abdominal injuries. This is a case report of ADH with bowel obstruction following an old penetrating abdominal trauma without any signs and symptoms of respiratory distress.
... Symptoms may be intermittent or acute depending on the extent of herniation of abdominal viscera into the thorax. Acute presentation is usually due to incarceration, obstruction, or strangulation of the hernia (Hung et al., 2008;Kocakusak et al., 2005). Diagnosis is ascertained by a combination of chest X-rays, computed tomography (CT), as well as upper gastrointestinal and bowel double-contrast study. ...
Abstract
Introduction: Congenital left diaphragmatic hernia of Bochdalek rarely occurs in adults. There are fewer than 100 cases of left-sided Bochdalek hernia reported in adults in the literature. Most of them are asymptomatic. Bochdalek hernias typically arise on the left side, contain fat or omentum, stomach, part of colon transverse, predominantly and small intestinal loops.
Aim: The aim of this paper is to present a rare case of Bochdalek hernia in adults and to point out the important role of Computed tomography (CT) in reaching the exact diagnosis of this abnormality.
Case report: We presented a rare case of a 46-year old female with left-sided Bochdalek diaphragmatic hernia, came to the Clinic of Surgery complaining of abdominal pain in the lower abdomen. The chest radiograph showed features suggestive of left-sided diaphragmatic hernia, which was confirmed using Multi-Dimensional Computed Tomography (MDCT).
Conclusion: Bochdalek hernia in adults occurs most frequently when the patients are undergoing CT for reasons that appear to be unrelated to the hernia.
Key Words: Adult; Bochdalek; Computed Tomography; Congenital; Diaphragmatic; Hernia.
... Most of the BH cases are incidental, asymptomatic posterolateral diaphragmatic defects. Rare cases of BH in adults where symptoms are present might result in incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease [3], [6], [7]. ...
BACKGROUND: Bochdalek hernia is a type of congenital diaphragmatic hernia (CDH), which more commonly affects children. Congenital left diaphragmatic hernias, such as Bochdalek, rarely occur in adults. Most such cases do not present any symptoms.
... Most of the BH cases are incidental, asymptomatic posterolateral diaphragmatic defects. Rare cases of BH in adults where symptoms are present might result in incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease [3], [6], [7]. ...
BACKGROUND: Bochdalek hernia is a type of congenital diaphragmatic hernia (CDH), which more commonly affects children. Congenital left diaphragmatic hernias, such as Bochdalek, rarely occur in adults. Most such cases do not present any symptoms.
CASE PRESENTATION: Here, we report the case of a 60-year-old male with a left-sided Bochdalek diaphragmatic hernia, who presented with abdominal pain and dyspnea. The patient was successfully treated by laparoscopic approach.
CONCLUSION: The 60-year-old male patient had left-sided BH and was successfully cured by the laparoscopic approach.
... A single article reported two cases and the remainder were single case reports. 5 Seven were treated with thoracotomy, seven via laparotomy, three with laparoscopy, three with thoraco-laparotomy and one declined surgery. 6 None of them had a previous abdominal surgery or abdominal pathologies. ...
... This opening is most commonly a 2cm defect located just superior to the adrenal gland. [7] 85% of Bochdalek hernias occur on the left side. [8] Left -sided Bochdalek hernias may contain spleen, stomach, small bowel, omentum, pancreas, adrenal gland or colon, whilst right -sided hernias can contain liver, gallbladder, kidney, omentum or bowel. ...
A Bochdalek hernia is an uncommon presentation in an adult patient. When present they tend to be left - sided, asymptomatic and rarely contain large bowel. When symptomatic, Bochdalek hernias in adults tend to cause gastro - intestinal symptoms in contrast to the paediatric population where respiratory symptoms are typical. Contrast induced CT chest and abdomen has a high sensitivity for diagnosis of Bochdalek hernias, and when demonstrated, they should be managed surgically with either minimally invasive or open surgery.
