Delayed diagnosis of infarcted small bowel due to right-sided Bochdalek hernia

Owen, Maureen; Rowley, GC; Tighe, M.; Wake, P

doi:10.1308/147870807x160407

Cited by 14 publications

(13 citation statements)

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“…[ 4 ] The prime factor is the rise in intraabdominal pressure and may be due to several causes, including persistent coughing/chronic obstructive airway disease (COPD),[ 37 38 ] vigorous physical activity, sneezing, chronic constipation,[ 44 ] retching, large meals, diving, fits of laughter, pregnancy, and childbirth. [ 9 10 11 12 52 54 55 56 57 58 59 ]…”

Section: Precipitating Factorsmentioning

confidence: 99%

“…Overall, 5.3% of the adult patients with BH in our review were pregnant. [ 9 10 11 12 54 55 56 57 58 59 60 61 62 ] Pregnancy has been found to be the most significant predisposing factor and is seen in 34% of cases where at least one precipitating factor is noted. [ 4 ] The management of these patients and the timing of surgical repair with regard to the stage of pregnancy is debatable.…”

Section: Association With Pregnancymentioning

confidence: 99%

“…[ 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:…”

Section: Repairmentioning

confidence: 99%

“…Most agree that all fit patients who are symptomatic and even those who are asymptomatic and detected incidentally should undergo surgical repair. [ 1 5 8 10 12 27 60 ] The argument in favor of such an approach is that a significant number of these patients present acutely with serious complications such as strangulation of the gut, leading to severe morbidity and mortality. [ 4 12 27 61 ]…”

Section: Repairmentioning

confidence: 99%

“…[ 1 4 5 6 7 8 ] Several factors that raise the intraabdominal pressure may predispose to it, with pregnancy being the most predominant. [ 9 10 11 12 ] While most of these hernias are symptomatic and present with pain or complications such as strangulation,[ 4 6 8 11 13 14 ] there are others that are detected incidentally during investigations for another cause. [ 3 15 ] Unfortunately, some of these patients are misdiagnosed, leading to serious consequence.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.

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Section: Precipitating Factorsmentioning

confidence: 99%

Section: Association With Pregnancymentioning

confidence: 99%

Section: Repairmentioning

confidence: 99%

Section: Repairmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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Bochdalek hernia in the adult: demographics, presentation, and surgical management

Brown

Horton

Trivette

et al. 2010

Hernia

125

129

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A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway

Ramspott

Jäger

Lechner

et al. 2021

Hernia

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Purpose Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed. Results Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented. Conclusion This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed.

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Delayed diagnosis of infarcted small bowel due to right-sided Bochdalek hernia

Cited by 14 publications

References 4 publications

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Bochdalek hernia in the adult: demographics, presentation, and surgical management

A systematic review on diagnostics and surgical treatment of adult right-sided Bochdalek hernias and presentation of the current management pathway

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