Research: Right-sided Bochdalek hernia in an adult with hepatic malformation and intestinal malrotation

Surg Case Rep

. 2021 Jul 17;7(1):169. doi: 10.1186/s40792-021-01232-5.

Right-sided Bochdalek hernia in an adult with hepatic malformation and intestinal malrotation

Naoki Enomoto 1Kazuhiko Yamada 2Daiki Kato 1Shusuke Yagi 1Hitomi Wake 1Kyoko Nohara 1Nobuyuki Takemura 1Tomomichi Kiyomatsu 1Norihiro Kokudo 1Affiliations expand

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Background: Bochdalek hernia is a common congenital diaphragmatic defect that usually manifests with cardiopulmonary insufficiency in neonates. It is very rare in adults, and symptomatic cases are mostly left-sided. Diaphragmatic defects generally warrant immediate surgical intervention to reduce the risk of incarceration or strangulation of the displaced viscera.

Case presentation: A 47-year-old woman presented with dyspnea on exertion. Computed tomography revealed that a large part of the intestinal loop with superior mesenteric vessels and the right kidney were displaced into the right thoracic cavity. Preoperative three-dimensional (3D) simulation software visualized detailed anatomy of displaced viscera and the precise location and size of the diaphragmatic defect. She underwent elective surgery after concomitant pulmonary hypertension was stabilized preoperatively. The laparotomic approach was adopted. Malformation of the liver and the presence of intestinal malrotation were confirmed during the operation. The distal part of the duodenum, jejunum, ileum, colon, and right kidney were reduced into the abdominal cavity consecutively. A large-sized oval defect was closed with monofilament polypropylene mesh. No complications occurred postoperatively.

Conclusion: Symptomatic right-sided Bochdalek hernia in adults is exceedingly rare and is frequently accompanied by various visceral anomalies. Accurate diagnosis and appropriate surgical repair are crucial to prevent possible incarceration or strangulation. The preoperative 3D simulation provided comprehensive information on anatomy and concomitant anomalies and helped surgeons plan the operation meticulously and perform procedures safely.

Keywords: Adult; Bochdalek hernia; Hepatic malformation; Intestinal malrotation; Right-sided; Three-dimensional simulation.

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