Bochdalek hernia causing type II respiratory failure in an elderly patient

Abstract

Bochdalek hernias occur as a result of a congenital defect in the diaphragm enabling abdominal viscera to enter the thoracic cavity restricting lung expansion and ventilation. Bochdalek hernias, in the majority of cases, present in neonates and very rarely in adults. To the best of our knowledge, there are only four published cases of Bochdalek hernia in the adult population causing respiratory failure. We present the case of an 87-year-old woman who had three admissions in the past 6 months with type II respiratory failure due to a Bochdalek hernia which we believe was congenital but had gradually increased in size over the years to cause progressive decompensation with acute exacerbations requiring non-invasive ventilation.

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

“…[ 61 ] Historically these patients were managed either by an open transabdominal or by a transthoracic approach. However, with the expansion of laparoscopic[ 4 7 8 9 10 12 24 25 26 27 28 ] and thoracoscopic[ 74 75 76 77 78 79 80 81 82 83 84 85 ] expertise and advances in instruments, the minimally invasive approach has emerged as an attractive option. There are, however, several areas of debate and these include the following:…”

“…[ 4 5 8 10 76 77 78 79 80 ] For emergent cases, laparotomy is the favored approach, using either a midline or subcostal, or in difficult cases a thoracoabdominal, incision. [ 4 7 8 41 79 ] This achieves better visualization of diaphragm on the left side and on the right side; the same is achieved following the mobilization of the right lobe of the liver. [ 1 81 82 ] Laparotomy has the advantage of identifying the position of the viscera after the “pull back” of hernia content and repairing the malrotation, if any.…”

“…[ 74 ] The abdominal cavity is inspected through the defect by thoracoscope to ensure safe placement of the herniated organ without malrotation. [ 79 ] Some patients undergo minithoracotomy for placement of mesh. [ 74 75 76 ]…”