Bochdalek hernias associated with intrathoracic kidney: A case report and systematic review of outcomes including renal function

Abstract

Background: An intrathoracic kidney is a very rare form of ectopic kidney. Though increasingly recognized in the literature, impact on renal function is less well described. We report the case of a 67-yearold South Asian gentleman who presented with intrathoracic kidney and chronic kidney disease. We carried out a systematic review of the available literature on intrathoracic kidney, in order to characterize the typical clinical features, and describe likely clinical course and possible renal and extra-renal complications associated with this form of ectopia. Materials and methods: A structured search using PubMed identified all relevant published case reports from 1988 to 2018, with search restricted to papers in English, and to adult cases only (> 18 years of age). 124 records were identified, and after screening for eligibility, 34 case reports were analyzed. Results: Median age was 53.5 years, with no gender predominance. 68% (27/34) of cases were symptomatic. 29% (10/34) had a significant complication associated with their intrathoracic kidney, with 3 cases with either documented chronic or end-stage kidney disease. 26% (9/34) required surgical intervention. Conclusion: Though previously regarded as a benign entity, results from our systematic review, bearing in mind susceptibility to publication bias, suggests an appreciable risk of symptoms, complications, and in the minority a risk to kidney function. We recommend close biochemical and imaging surveillance of affected patients, with low threshold for intervention in those with renovascular stenosis, reflux, or hydronephrosis.

Fatal Outcome in a Right Bochdalek Hernia with Renal Ectopia Diagnosed in Adulthood

“…Treatment is recommended when diaphragmatic hernia is accompanied by intestinal content, when there are complications in any of the hernia's contents (as in the present case), when the ureter is obstructed or there is vesicoureteral reflux [9] [11]. Some authors recommend, in addition to hernia repair, nephropexy [12] [13]. Hernia repair can be performed by the abdominal or thoracic route, by open surgery, by laparoscopy and even by a robot-assisted technique, using mixed approaches and hybrid procedures.…”

Intrathoracic kidney

“…The vast majority of congenital diaphragmatic hernias are detected and corrected in childhood, which is one of the reasons why the long-term prognosis of this condition is poorly defined. [1,4] Our case was interpreted as an incidental finding and since the patient's comorbidities such as hypertension and diabetes mellitus could have caused her chronic kidney disease, we are not able to determine if the kidney ectopia was a contributing factor. Although renal ectopia may predispose to renal disease or complicate surgical procedures and pregnancy, it is also compatible with a long asymptomatic life, as in our patient.…”

“…The vast majority of congenital diaphragmatic hernias are detected and corrected in childhood, which is one of the reasons why the long-term prognosis of this condition is poorly defined. [ 1 , 4 ]…”

Fatal adult-onset diaphragmatic hernia in the context of the COVID-19 pandemic

“…5 A study 29 reported that among 13,138 abdominal CT scans performed in an institution over one year, 22 asymptomatic incidental Bochdalek hernias were found in adults, translating to roughly 0.17%. Usually, the stomach, large bowel or small bowel and omentum that usually herniates, but there are reports wherein spleen 30 or a kidney 31 gets dragged into the thoracic cavity. In the present case, we found omentum, along with the gastric fundus and a loop of the gangrenous small intestine in the thoracic cavity.…”