Bochdalek Hernia in Adults: A Report of Two Cases with a Review of the Japanese Literature

Abstract

We describe 2 challenging adult cases of Bochdalek hernia. The first case is that of a 22-year-old man who presented with left upper abdominal pain. The second case is that of a 36-year-old man who reported coughing after eating. In both cases, computed tomography revealed a defect in the left posterior attachment of the diaphragm. There was no vesical hernia, but parts of the greater omentum had prolapsed into the thoracic cavity in the first case, and parts of stomach, small intestine, colon, kidney, pancreas, and spleen had prolapsed into the thoracic cavity in the second case. In the first case, we were able to close the hernia defect with sutures by means of thoracoscopic surgery, and in the other case, that of a massive hernia, closure by means of laparoscopic surgery was difficult. We converted to laparotomy to perform suture closure, and we added a mesh patch.Bochdalek hernia is a congenital diaphragmatic defect that is usually apparent in the neonatal period. Discovery of a Bochdalek hernia in an adult is rare. Surgical treatment is necessary, but there are different approaches. Selection of the appropriate procedure depends the advantage to be gained by one approach over another in each particular case. The number of reports on thoracoscopic and laparoscopic surgery for treatment of Bochdalek hernia have increased in recent years. We think that endoscopic surgery for Bochdalek hernia will increase in popularity due to improvements in techniques and devices. We describe our 2 cases in detail and review our experience in light of the available Japanese literature.