Bochdalek hernia in an adult: two case reports and a review of perioperative cardiopulmonary complications

Abstract

Background: Bochdalek hernia in an adult is very rare and often needs an immediate surgical repair for the herniation. Although its etiology and surgical techniques have frequently been reported, perioperative complications, especially cardiopulmonary problems, remain unknown. We reported two adults with Bochdalek hernia and reviewed the published literatures with a focus on these issues. Case presentation: We experienced two adult cases of Bochdalek hernia with gastrointestinal strangulation. One case had massive herniation of the stomach, colon, spleen, and pancreas in the left chest, causing repeated vomiting. The other had a right-side hernia with strangulation of the colon. We successfully performed emergency repairs of these diaphragmatic hernias without any postoperative complications. Conclusions: Our literature review revealed that life-threatening cardiopulmonary complications, such as empyema or cardiac arrest caused by the tamponade effect of the herniated viscera, sometimes occurred in patients with Bochdalek hernia. These complications were found in Bochdalek hernia with gastrointestinal strangulation.

Lung volume recovery and improvement of pulmonary hypertension following surgical repair for Bochdalek hernia

“…2 We initially considered that the collapsed lung would be unable to expand postoperatively because there has been no report of the re-expansion of the collapsed lung following surgery. 3 To our knowledge, this is the first report of the achievement of hypoplastic lung re-expansion by aggressive positive pressure ventilation using a home non-invasive ventilator. Further, the pulmonary hypertension was resolved following surgical repair.…”

Bochdalek Hernia in an Adult Causing Intraoperative Complication

“…Bochdalek hernia is a type of congenital diaphragmatic hernia that occurs due to the failure of closure of the pleuroperitoneal folds causing a defect in posterolateral diaphragmatic formation [ 7 ]. This defect can lead to protrusion of abdominal contents into the thoracic cavity thereby interfering with lung development.…”

“…This presents as severe cardiopulmonary complications in perinatal life like lung hypoplasia or pulmonary hypertension. The incidence of this condition is 0.8-5/10,000 births [ 7 ]. Rarely, the hernia can remain asymptomatic until adulthood where initial presentation can be pulmonary or abdominal complaints.…”

Bochdalek Hernia and Partial Diaphragmatic Agenesis: Pedicled Intercostal Muscle Flap and Mesh Repair in a Young Adult with Sickle Cell Disease

“… 1 Due to varied clinical presentations, diagnosis is late. 4 Volvulus, strangulation, organ perforation, and tension pneumothorax require emergency intervention. 4 Contents include omentum (92%), splenic flexure of the colon (58%), stomach (25%), spleen and liver.…”