Combined laparoscopic and thoracoscopic repair of adult right-sided Bochdalek hernia with massive liver prolapse: A case report

BACKGROUND A Bochdalek hernia(BH)is a congenital diaphragmatic hernia that often develops in the neonatal period.BH typically occurs on the left side of the diaphragm.A right-sided BH in an adult is rare.CASE SUMMARY A 45-year-old man was referred to our hospital because of an abnormal shadow seen on chest radiography during a medical check-up.A chest radiograph showed elevation of the right hemidiaphragm.Computed tomography showed prolapse of multiple intraabdominal organs into the right thoracic cavity,corresponding to a right-sided BH.The herniated contents included the stomach,transverse colon,and left lobe of the liver.The left lobe of the liver was enlarged,particularly the medial segment.Laparoscopic surgery was performed.However,the left lobe of the liver was completely trapped in the thoracic cavity.Therefore,thoracoscopic manipulation had to be performed to return the liver to the abdominal cavity.The hernia was repaired with interrupted nonabsorbable sutures and reinforced with mesh.CONCLUSION Combined laparoscopic and thoracoscopic surgery was successfully performed for right-sided BH with massive liver prolapse and abnormal liver morphology.

Respiratory Distress Indicative of a Right Bochdalek Hernia in a Central African Newborn

Congenital cupola diaphragmatic hernia (CDH) is a congenital embryopathy which is defined by the absence of development of all or part of a diaphragmatic cupola. We report a case of posterolateral diaphragmatic hernia called right Bochdalek hernia in a three-day-old newborn hospitalized in the neonatology department of the Center Hospitalier Universitaire Pédiatrique de Bangui (CHUPB) for respiratory discomfort, vomiting and fever. Unsuccessful treatment for neonatal staphylococcal infection diagnosis of diaphragmatic hernia was suggested and confirmed on day 18 of life by computed tomography and intraoperatively.

An 81-year-old gentleman with symptomatic Bochdalek hernia

An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia.

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

Diaphragmatic hernias may be acquired or congenital. Among congenital hernias, the most common is Bochdalek hernia and eight out of ten Bochdalek hernias occur on the left side. They are usually diagnosed in the paediatric age group, and it is exceedingly rare for the diagnosis to be established in adulthood. Renal ectopy associated with a Bochdalek hernia is extremely rare, and very few cases are reported worldwide. We are reporting a case of a 73-year-old male patient with a right-sided Bochdalek hernia and renal ectopy. In this case, promp diagnosis and treatment could help to reduce the high risk of death in this kind of patients.

Congenital Diaphragmatic Hernia with Delayed Diagnosis: Report of Two Cases

Introduction: Advances in prenatal imaging studies have allowed early diagnosis of Congenital Diaphragmatic Hernia (CDH), although neonatal mortality remains at high levels (60% survival). Despite advances, this study found delayed diagnosis, demonstrating subdiagnosis, possibly caused by lack of resources and/or prenatal diagnostic failure. Case Report 1: Infant, 4 months and 22 days old, dyspneic, cyanotic, with fever and vomiting for 3 days, treated as pneumonia. After the second chest radiography, a right CDH was revealed. Surgical correction was performed and removal of Meckel’s diverticulum was surgical findings. The patient was discharged on the 10th days after admission. Case Report 2: Infant, 11 months and 3 days old, distended abdomen, with fever and dyspnea for 2 days, treated as pneumonia. After the second chest radiography, a left CDH was revealed. The patient was submitted to surgery, intestinal loop incarceration without necrosis was observed, and the correction of CDH was performed. The patient was discharged on the 7th day after admission. Discussion: Three cases, between July 2012 and July 2013, were diagnosed at Dom Malam Hospital;2 Cases of CDH, with delayed diagnosis, showed incidence of 66.66%. Delayed diagnosis of these patients with initial hypotheses of pneumonia demonstrated high risk, emphasizing the importance of diagnosis research through observation of the clinical course, the correct imaging interpretation, in order to establish early diagnosis and treatment.

新生儿及婴幼儿胸腹裂孔疝诊治的临床特点

目的总结先天性胸腹裂孔疝的临床特点及诊治经验,以提高治愈率及成活患儿的生活质量。方法回顾分析1983年8月～2004年6月诊治的25例先天性胸腹裂孔疝。1998年4月以前诊治8例,其中新生儿5例,婴幼儿3例;1998年4月～2004年6月诊治17例,其中新生儿10例,婴幼儿7例。左侧22例,右侧3例。行手术治疗24例,另1例未及手术即死亡。结果1998年4月以前诊治的8例,术后7例成活,并获随访1年3个月～11年,无任何呼吸道症状,生长发育良好;死亡1例系早产儿,入院时出现紫绀、呼吸衰竭,尸检发现其肺体积甚小。1998年4月～2004年6月诊治的17例,术后15例成活,2例新生儿死于呼吸衰竭。结论新生儿患儿呼吸困难出现越早,病情越严重;婴幼儿病情相对稳定。及时规范的处理可提高治愈率,延期手术应视患儿具体情况而定。

儿童胸腹裂孔疝及膈肌缺如的治疗

目的 介绍肋骨瓣加涤纶布在膈肌缺如患儿膈肌重建术中的体会 ,探讨儿童胸腹裂孔疝的诊治方法。方法 通过对胸腹裂孔疝 10例患儿的诊断、误诊原因、膈肌缺损的修补方法及膈肌缺如 2例膈肌重建疗效进行回顾性分析。结果 12例首诊均误诊。 10例经腹手术及 2例膈肌重建后均治愈。结论 儿童胸腹裂孔疝临床表现缺乏特异性 ,易误诊 ,诊断一经确定 ,应尽早手术。膈肌缺如应重建 。

成人胸腔肾的X线及CT诊断

目的总结成人胸腔肾的X线和CT表现特点及探讨其发生机制。方法分析6例经CT诊断胸腔肾患者的影像资料并结合相关文献进行回顾。结果 6例胸腔肾均位于左侧,胸部X线平片显示左下胸心影后类圆形团片阴影、左膈局限性膨出或左膈影抬高。5例胸腔肾合并Bochdalek疝,CT表现为左膈肌后侧中断缺损,缺损缘变薄,左肾上极部分疝入胸腔,其中1例合并腹主动脉后左肾静脉变异;1例胸腔肾为外伤导致,CT表现为左侧膈肌后侧破裂缺损,其断端增厚,左肾和脾脏完全疝入胸腔内。6例胸腔肾均无肾盂及输尿管积水表现。结论胸腔肾在临床较为少见,CT能够准确显示膈肌缺损位置及肾脏疝入胸腔的情况,根据CT征象判断胸腔肾的类型及其发生机制,可指导临床治疗及随访。

Bochdalek疝的MSCT诊断及其与代谢综合征的相关性分析

目的：探讨Bochdalek疝的多层螺旋CT（MSCT）表现及其进展程度与代谢综合征（MS）的相关性。方法：回顾性分析55例Bochdalek疝患者的临床和影像学资料，总结Bochdalek疝患者的影像学表现，分析Bochdalek疝患者MS的发生情况。结果：Bochdalek疝表现为一侧或双侧膈肌局限性薄弱或缺损；合并MS患者的Bochdalek疝囊更加明显。结论：Bochdalek疝通过MSCT平扫和多平面重组MPR即可明确诊断，其发展与MS呈正相关。