Research: Laparoscopic repair of colonoscopy-induced adult Bochdalek hernia: Case report

Int J Surg Case Rep

. 2022 Sep 5;99:107591.

 doi: 10.1016/j.ijscr.2022.107591. Online ahead of print.

Laparoscopic repair of colonoscopy-induced adult Bochdalek hernia: Case report

Sung Hoon Cho 1Kyoung Hoon Lim 2

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Introduction: Bochdalek hernias are congenital diaphragmatic malformations caused by a failure to close the pleuroperitoneal cavity in the posterolateral area. Bochdalek hernias are very rare in adult, with congenital diaphragmatic defects being even rarer.

Presentation of case: A 35-year-old man presented to our emergency room with epigastric pain after colonoscopy. The patient had no history of trauma. Plain chest X-ray revealed bowel gas patterns and haziness in the left lower lung field. Abdominal computed tomography revealed a left diaphragmatic defect in the posterolateral area, with herniation of the omentum and colon. The patient successfully underwent laparoscopic herniorrhaphy.

Discussion: The diaphragm comprises fibrous tissue and muscle. Therefore, direct damage by a colonoscope is almost impossible. Normal chest X-ray as a part of a health screening was performed 9 days prior to admission, and the size of the diaphragmatic defect could be covered by the spleen; therefore, the patient was considered hernia-free for over 30 years.

Conclusion: We report a rare case of delayed Bochdalek hernia that may have been induced by the difficult insertion of a colonoscopy. Although rare, this disorder should be recognized, examined and treated appropriately to avoid complications.

Keywords: Adult; Bochdalek hernia; Colonoscopy; Laparoscopy.

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