Research: [Dagnostics and surgical treatment of Bochdalek hernia in adults]

Khirurgiia (Mosk)

. 2023;(6):48-55.

 doi: 10.17116/hirurgia202306148.

[Dagnostics and surgical treatment of Bochdalek hernia in adults]

[Article in Russian]

S A Plaksin 1L P Kotelnikova 1

Affiliations expand

Abstract in English, Russian

Objective: To estimate the incidence, diagnostic possibilities and surgical strategy for Bochdalek hernias in adults.

Material and methods: Bochdalek hernias were diagnosed in 7 (9.2%) out of 76 patients with diaphragmatic hernias (age 49-63 years). The left-sided hernia was diagnosed in 5 patients (71.4%), right-sided – 1 patient, bilateral hernia – 1 patient.

Results: The disease was diagnosed during routine X-ray examination in 5 cases. Two patients complained of breathlessness and abdominal pain. Computed tomography revealed displacement of retroperitoneal fat (n=6), kidney (n=3), adrenal gland (n=2), pancreas (n=1) and colon (n=1) towards the diaphragm. In one case, ureter angulation caused kidney dysfunction. Mean dimension of hernial orifice was 7.9±3.1 cm. Two patients without any clinical and functional manifestations did not require surgery. In 1 case, surgery was contraindicated due to cardiac comorbidities. The fourth one refused surgery. Three (42%) patients underwent surgery. In the first case, diaphragm repair was performed through the right-sided thoracic approach in combination with nephrectomy because of kidney dysfunction. In the second case, we performed left-sided thoracotomy, in one case – video-assisted thoracoscopy. One patient died from recurrent mesenteric thrombosis accompanied by bowel necrosis after nephrectomy.

Conclusion: Bochdalek hernias in adults are most often right-sided and contain fat tissue. Surgical treatment is required in case of displacement of internal organs, clinical manifestations, compression and functional disturbances.

Keywords: Bochdalek hernias; computed tomography; diagnostics; surgical treatment; thoracotomy; video-assisted thoracoscopy.

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