Dagnostics and surgical treatment of Bochdalek hernia in adults

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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

diagnostics

computed tomography

video-assisted thoracoscopy

thoracotomy

surgical treatment

Authors:

Plaksin S.A.

Vagner Perm State Medical University

ORCID: 0000-0001-8108-1655

Kotelnikova L.P.

Vagner Perm State Medical University

ORCID: 0000-0002-8602-1405

Received:

31.08.2022

Accepted:

10.12.2022

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