Hérnia de bochdalek em adulto

Abstract

Bochdalek´s hernia is a congenital malformation of the posterolateral diaphragm region. It is more common on the left and more frequently seen in newborns and rare in adults, with over a few 100 reported cases. We present a case of Bochdalek´s hernia in a 49-year-old patient with long term dyspeptic symptoms. The upper endoscopy showed a gastric fundus herniation sliding into the chest through the diaphragmatic defect. The patient also presented with a rare pulmonary malformation diagnosed during surgery. It was corrected through thoracic approach with no other complications (Rev. Col. Bras. Cir. 2008; 35(1): 040-044).

Incarcerated right-sided diaphragmatic hernia in a patient undergoing Roux-en-Y gastric bypass

“…It revealed that only 101 patients presented with right-sided diaphragmatic hernia 5 . A report from 2008 found 100 cases of BH described in the literature and among those there were 20 cases of right-sided hernia 6 . Some reports indicate that contents of left-sided hernias are usually colon, stomach, omentum, spleen, small bowel, pancreas and adrenal gland.…”

“…Therefore, a computed tomography (CT) or a magnetic resonance imaging (MRI) should be performed The surgical approach to repair a diaphragm defect can be transthoracic or transabdominal, regardless of being a laparoscopy or an open surgery 7,10 . Transthoracic approach is preferred for right-sided BH because it facilitates the exposure of the diaphragm 6 . However, when there is suspicion of obstruction or strangulation, the transabdominal option with a midline incision should be considered 6,7,10 in order to adequately evaluate visceral complications 6 .…”

“…Transthoracic approach is preferred for right-sided BH because it facilitates the exposure of the diaphragm 6 . However, when there is suspicion of obstruction or strangulation, the transabdominal option with a midline incision should be considered 6,7,10 in order to adequately evaluate visceral complications 6 . Regarding the closure of orifices, defects more than 5 cm in diameter should be repaired with tension-free mesh.…”

Gastric Obstruction in Adult by Congenital Diaphragmatic Hernia

“…Trata-se de uma malformação congênita incomum, que acomete 1 em 3000 nascidos vivos, mas com acentuada morbimortalidade. 1,2 A maioria dos casos apresentam-se nas primeiras horas ou dias de vida, sendo raros os casos sintomáticos na população adulta, em que se faz o diagnóstico tardiamente. 1,2 As HDC são raras em adultos, e possuem um espectro de apresentação desde assintomáticas ou podem haver sintomas vagos, como: dor torácica, dor abdominal, dispneia, empachamento e vômitos.…”

“…1,2 A maioria dos casos apresentam-se nas primeiras horas ou dias de vida, sendo raros os casos sintomáticos na população adulta, em que se faz o diagnóstico tardiamente. 1,2 As HDC são raras em adultos, e possuem um espectro de apresentação desde assintomáticas ou podem haver sintomas vagos, como: dor torácica, dor abdominal, dispneia, empachamento e vômitos. 3,4,5,6,7,8 Além disso, elas podem mimetizar as hérnias paraesofagenas, fazendo com que sua identificação seja difícil.…”