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Moncy AA, Ninan Oommen A, Joy RR. A Rare Complication in the Delayed Manifestation of Bochdalek Hernia During Pregnancy: A Case Report. Cureus 2023; 15:e40718. [PMID: 37485148 PMCID: PMC10360029 DOI: 10.7759/cureus.40718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Acute gastric volvulus is a surgical emergency and is known to occur secondary to diaphragmatic hernia and eventration. Adult presentation of congenital diaphragmatic hernia is rare, with an estimated incidence of around 0.17%, and pregnancy may predispose to the development of symptoms due to increased intra-abdominal pressure. Pregnancy complicated by diaphragmatic hernia is associated with a high risk of maternal and fetal mortality, necessitating timely diagnosis and treatment. We present the case of a 23-year-old female presenting with a symptomatic left Bochdalek hernia complicated by organo-axial gastric volvulus during her second trimester (27 weeks). Emergency laparotomy was performed, with Caesarean section, reduction of gastric volvulus, and mesh repair of the left posterolateral defect.
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Affiliation(s)
- Aneena A Moncy
- General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | - Ashok Ninan Oommen
- General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | - Rejana R Joy
- General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
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Maternal Bochdalek Hernia during Pregnancy: A Systematic Review of Case Reports. Diagnostics (Basel) 2021; 11:diagnostics11071261. [PMID: 34359342 PMCID: PMC8303225 DOI: 10.3390/diagnostics11071261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Since the first report of a diaphragmatic hernia from Ambroise Paré’s necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early. Data sources and study selection: A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups’ presence due to their rarity. Results: The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases. Conclusion: Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.
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Reddy M, Kroushev A, Palmer K. Undiagnosed maternal diaphragmatic hernia - a management dilemma. BMC Pregnancy Childbirth 2018; 18:237. [PMID: 29907140 PMCID: PMC6002987 DOI: 10.1186/s12884-018-1864-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/29/2018] [Indexed: 01/12/2023] Open
Abstract
Background Maternal diaphragmatic hernias identified during pregnancy are rare and pose significant management challenges with regards to timing and mode of both delivery and hernia repair. Case presentation We describe a case of a maternal diaphragmatic hernia diagnosed at 31 weeks gestation in the setting of acute upper abdominal pain. Due to no evidence of visceral compromise and a stable maternal condition, the patient was conservatively managed, allowing for further foetal maturation. Delivery by caesarean section occurred following concerns of malnutrition and partial bowel obstruction. This was followed by immediate surgical repair of the hernia. The patient had an uncomplicated recovery. Conclusion Maternal diaphragmatic hernias in pregnancy require multidisciplinary care and individualised management in order to allow for the optimal outcome for mother and foetus.
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Affiliation(s)
- Maya Reddy
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Level 5, Clayton, Vic, 3168, Australia.
| | - Annie Kroushev
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Level 5, Clayton, Vic, 3168, Australia
| | - Kirsten Palmer
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Level 5, Clayton, Vic, 3168, Australia.,Department of Obstetrics and Gynecology, Monash University, 246 Clayton Road, Clayton, VIC, Australia
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Suhardja TS, Vaska A, Foley D, Gribbin J. Adult Bochdalek hernia in a pregnant woman. ANZ J Surg 2017; 89:E162-E163. [PMID: 28749048 DOI: 10.1111/ans.14145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/04/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas S Suhardja
- Department of Upper GI Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Ashish Vaska
- Department of Upper GI Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Daniel Foley
- Department of Upper GI Surgery, Monash Health, Melbourne, Victoria, Australia
| | - John Gribbin
- Department of Upper GI Surgery, Monash Health, Melbourne, Victoria, Australia
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Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg 2017; 12:23. [PMID: 28529538 PMCID: PMC5437542 DOI: 10.1186/s13017-017-0134-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17-6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations. METHODS From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed. RESULTS Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful. CONCLUSION Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
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Affiliation(s)
- Mario Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Antonia Girardi
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Roberta Maria Isernia
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Angela De Palma
- Department of Thoracic Surgery, University of Bari, Bari, Italy
| | - Giovanni Catalano
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
| | - Angela Pezzolla
- Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Medical School “A. Moro” of Bari, Bari, Italy
| | - Angela Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School “Aldo Moro” of Bari, Bari, Italy
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Cheng HC. Expect the Unexpected - A Case of Traumatic Right Sided Diaphragmatic Hernia in Third Trimester and Literature Review. WOMENS HEALTH 2017. [DOI: 10.15406/mojwh.2017.05.00113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Machado NO. Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:65-74. [PMID: 27042603 PMCID: PMC4791901 DOI: 10.4103/1947-2714.177292] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
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8
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Brygger L, Fristrup CW, Harbo FSG, Jørgensen JS. Acute gastric incarceration from thoracic herniation in pregnancy following laparoscopic antireflux surgery. BMJ Case Rep 2013; 2013:bcr-2012-008391. [PMID: 23378556 DOI: 10.1136/bcr-2012-008391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Diaphragmatic hernia is a rare complication in pregnancy which due to misdiagnosis or management delays may be life-threatening. We report a case of a woman in the third trimester of pregnancy who presented with sudden onset of severe epigastric and thoracic pain radiating to the back. Earlier in the index pregnancy, she had undergone laparoscopic antireflux surgery (ARS) for a hiatus hernia because of severe gastro-oesophageal reflux. Owing to increasing epigastric pain a CT scan was carried out which diagnosed wrap disruption with gastric herniation into the thoracic cavity and threatened incarceration. This is, to our knowledge, the first report of severe adverse outcome after ARS during pregnancy, with acute intrathoracic gastric herniation. We recommend the avoidance of ARS in pregnancy, and the need to advise women undergoing ARS of the postoperative risks if pregnancy occurs within a few years of ARS.
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Affiliation(s)
- Louise Brygger
- Department of Obstetrics & Gynaecology, Odense University Hospital, Denmark
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9
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Abstract
We present the case of a 30-year-old woman admitted at 38 weeks and 3 days gestation with a rare cause of bowel obstruction. Definitive diagnosis was not made until laparotomy. We present the unique management challenges posed and a review of the literature.
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Affiliation(s)
- Yingda Li
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Megan Ang
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Julie A Miller
- Department of Surgery, Royal Melbourne Hospital, Parkville, Vic., Australia
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10
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Ngai I, Sheen JJ, Govindappagari S, Garry DJ. Bochdalek hernia in pregnancy. BMJ Case Rep 2012; 2012:bcr-2012-006859. [PMID: 22967686 DOI: 10.1136/bcr-2012-006859] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Asymptomatic diaphragmatic hernias in reproductive-aged women are rare but pose significant morbidity for pregnancy. This is a case of a woman at 29 weeks' gestation with abdominal pain and shortness of breath. Five years prior she had been incidentally diagnosed with a small congenital diaphragmatic hernia of Bochdalek. Following preconception care, she opted against repair of the hernia prior to pregnancy due to lack of symptoms and no clear recommendation for repair from the surgeon. Imaging studies on emergency room presentation demonstrated a large herniation of viscera into her chest occupying her entire left chest with slight cardiac displacement. Through a multidisciplinary approach, she was stabilised and eventually delivered at 31 weeks due to worsening pulmonary function. The hernia was repaired postpartum. We recommend repair of any diaphragmatic hernia prior to conception to prevent significant maternal and fetal morbidity or mortality. A multidisciplinary approach allows for planning.
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Affiliation(s)
- Ivan Ngai
- Montefiore Medical Center/Einstein Medical College, Bronx, New York, USA
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11
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Servais EL, Stiles BM, Finnerty BM, Paul S. Ruptured Diaphragmatic Eventration: A Rare Cause of Acute Postpartum Dyspnea. Ann Thorac Surg 2012; 93:e143-4. [DOI: 10.1016/j.athoracsur.2011.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 12/03/2011] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
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Chen X, Yang X, Cheng W. Diaphragmatic tear in pregnancy induced by intractable vomiting: a case report and review of the literature. J Matern Fetal Neonatal Med 2011; 25:1822-4. [PMID: 22098059 DOI: 10.3109/14767058.2011.640371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Nausea and vomiting of pregnancy, the most common medical condition of pregnancy, affects up to 80% of all pregnancies to some extent, and hyperemesis gravidarum does less than 1% of pregnant women. When hyperemesis gravidarum induces diaphragmatic tear, diagnosis can be missed because of nonspecific presentation with abdominal pain, nausea and vomiting. METHODS We reported a pregnant case suffering from intractable vomiting at the beginning of the second trimester (the 13th week of gestation) with delayed diagnosis of diaphragmatic tearing. RESULTS The patient was misdiagnosed initially, which delayed the surgical intervention and unnecessary abortion. CONCLUSION It is worthwhile considering the maternal diaphragmatic cause as an unusual one of refractory vomiting accompanied by clinically significant progressive epigastric pain, distension and respiratory embarrassment.
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Affiliation(s)
- Xinliang Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Jiaotong University, Shanghai, China
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13
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Julien F, Drolet S, Lévesque I, Bouchard A. The right lateral position for laparoscopic diaphragmatic hernia repair in pregnancy: technique and review of the literature. J Laparoendosc Adv Surg Tech A 2011; 21:67-70. [PMID: 21314565 DOI: 10.1089/lap.2010.0461] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Maternal diaphragmatic hernia is a rare disorder of pregnancy. Laparoscopic repair of diaphragmatic hernias is gaining more and more consideration among the surgical community. To date, only a few centers have reported using the laparoscopic approach for diaphragmatic hernias occurring in pregnancy. As congenital diaphragmatic hernias occur mostly on the left side, a right lateral position would theoretically facilitate the surgery and would render an eventual simultaneous left thoracoscopy feasible without repositioning the patient. However, such a position in a pregnant woman has serious implications because of possible inferior vena cava compression by the gravid uterus. We performed a laparoscopic reduction and repair of a left foramen of Bochdalek hernia in a 26-week-pregnant patient, using a right lateral position. The right lateral position facilitated the procedure, without any adverse outcome for the fetus or the mother. This approach should be considered for any left diaphragmatic hernia repair occurring in pregnancy.
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Affiliation(s)
- François Julien
- Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, Canada
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14
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Chen Y, Hou Q, Zhang Z, Zhang J, Xi M. Diaphragmatic hernia during pregnancy: a case report with a review of the literature from the past 50 years. J Obstet Gynaecol Res 2011; 37:709-14. [PMID: 21410835 DOI: 10.1111/j.1447-0756.2010.01451.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diaphragmatic hernia is a rare complication during pregnancy. Only 30 reports have been published on this subject in English between 1959 and 2009. Due to misdiagnoses and management delays, diaphragmatic hernia usually presents itself as a life-threatening emergency. Here, we present a case report of a patient with a traumatic diaphragmatic hernia who became acutely symptomatic during pregnancy. The diaphragmatic hernia was managed successfully, and we describe the presentation, management and outcome of this case. We also present a review of all of the reported cases of diaphragmatic hernias complicating pregnancy that have been published in English during the past 50 years.
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Affiliation(s)
- Yue Chen
- West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Khandelwal M, Krueger C. Diaphragmatic hernia after laparoscopic esophagomyotomy for esophageal achalasia in pregnancy. ISRN GASTROENTEROLOGY 2010; 2011:871958. [PMID: 21991532 PMCID: PMC3168564 DOI: 10.5402/2011/871958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/07/2010] [Indexed: 11/23/2022]
Abstract
Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.
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Affiliation(s)
- Meena Khandelwal
- Department of Obstetrics & Gynecology, Cooper University Hospital, University of Medicine & Dentistry of New Jersey, 1 Cooper Plaza, 623 Dorrance Building, Camden, NJ 08103, USA
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16
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Laparoscopic dual mesh repair of a diaphragmatic hernia of Bochdalek in a symptomatic elderly patient. Updates Surg 2010; 62:125-8. [PMID: 20859719 DOI: 10.1007/s13304-010-0022-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
Bochdalek hernia is a congenital posterolateral diaphragmatic defect. It is usually diagnosed in newborns and children; the mortality rate is high due to further congenital anomalies such as pulmonary hypoplasia and pulmonary hypertension. In adulthood, the diagnosis is often incidental, while sometimes it is related to gastrointestinal or respiratory symptoms, or to herniated viscera complications. Thus, surgical treatment is advocated. We herein report a case of an 86-year-old woman with dyspnea and dysphagia. After the diagnosis by barium enema and CT scan of the herniated stomach and the greater omentum through a left side foramen of Bochdalek, she underwent a successful laparoscopic dual mesh repair and was discharged on the 6th postoperative day.
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17
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Brown SR, Horton JD, Trivette E, Hofmann LJ, Johnson JM. Bochdalek hernia in the adult: demographics, presentation, and surgical management. Hernia 2010; 15:23-30. [PMID: 20614149 DOI: 10.1007/s10029-010-0699-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 06/12/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bochdalek hernias are a very rare form of diaphragmatic hernias. There are no robust studies that reveal the true natural history of this disease process. The aim of this study was to summarize clinically relevant data for the purpose of assisting surgeons with the work-up, diagnosis, and treatment of adult patients with Bochdalek hernia. METHODS A literature search was performed using PubMed, Google scholar, EMBASE and the following keywords: Bochdalek hernia, congenital diaphragmatic hernia, and posterolateral hernia. All case reports and series after 1955 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies utilized during work-up, laterality, surgical approach, hernia sac management, specific minimally invasive surgical techniques, and follow-up. RESULTS A total of 124 articles comprising 173 patients met the inclusion criteria. Based on the data provided, several conclusions regarding this disease process can be made. Most patients present with symptoms related to their hernia (86%). Pain is the most common complaint (69%). While laparotomy is the most widely used surgical approach (38%), minimally invasive surgical techniques have gained popularity since their first report in 1995. Laparoscopic repair can be performed with a low complication rate (7%) and short hospital stay (4 days). CONCLUSIONS Using modern surgical techniques to include laparoscopy, repair can be performed safely, with a short hospital stay, and with minimal morbidity or mortality.
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Affiliation(s)
- S R Brown
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras St, El Paso, TX 79920, USA.
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18
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Abstract
Bochdalek hernia is a rare surgical condition primarily diagnosed in infants. Morgagni hernia is more commonly identified in adults. A subset of patients with a Bochdalek hernia, especially those with a right-sided defect, may also be diagnosed during adulthood. Both adult forms of CDH may be discovered incidentally or diagnosed as part of the investigation of nonspecific gastrointestinal or respiratory symptoms. It is recommended that all adult CDH patients undergo surgical repair to prevent incarceration and strangulation of abdominal viscera. Currently, many reports have demonstrated the safety and efficacy of using open or minimally invasive repairtechniques, with or without mesh reinforcement. Regardless of the approach selected, surgical repair has been associated with low morbidity and mortality and excellent long-term outcomes with low rate of recurrence.
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19
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Osman I, McKernan M, Rae DW. Normal vaginal delivery following rupture of the maternal diaphragm in pregnancy. J OBSTET GYNAECOL 2008; 27:625-7. [PMID: 17896272 DOI: 10.1080/01443610701554247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- I Osman
- Ayrshire Central Hospital, Irvine, UK.
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20
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Affiliation(s)
- P Agarwal
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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21
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Luu TD, Reddy VS, Miller DL, Force SD. Gastric rupture associated with diaphragmatic hernia during pregnancy. Ann Thorac Surg 2006; 82:1908-10. [PMID: 17062278 DOI: 10.1016/j.athoracsur.2006.02.083] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 02/20/2006] [Accepted: 02/22/2006] [Indexed: 10/24/2022]
Abstract
Diaphragmatic hernia complicating pregnancy rarely occurs, but it is frequently misdiagnosed. A strangulated diaphragmatic hernia in a pregnant patient presents a true surgical emergency, and delay in operative intervention can result in fetal and maternal mortality in as many as 50% of cases. We describe a case report of a pregnant patient and her fetus surviving after a spontaneous gastric rupture from a strangulated diaphragmatic hernia.
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Affiliation(s)
- Theresa D Luu
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Abstract
BACKGROUND Diaphragmatic hernias complicating pregnancy are not a common problem but they can have catastrophic consequences. They can present to the surgeon as a life-threatening emergency or pose a management dilemma when detected incidentally. In this paper, recommendations for the management of non-hiatal maternal diaphragmatic hernias are made based on our experience and the available published reports. METHODS The presentation, management and outcomes of a series of three recent cases are described. A review of all other reported cases of diaphragmatic hernias complicating pregnancy was also carried out. RESULTS All three cases were emergency presentations in the third trimester of pregnancy, resulting from compression of thoracic contents. All cases required emergency laparotomy and one also required thoracotomy. Delivery was by Caesarean section at the time of emergency surgery in two cases and was delayed in the third case. There was one fetal and no maternal deaths. One mother suffered persistent pleural infection. One baby also had a diaphragmatic hernia requiring postnatal repair. Published reports showed only 36 previously reported cases of diaphragmatic hernias identified in pregnancy. There is a consensus that hernias presenting with evidence of strangulation represent a surgical emergency and mandate operative management, irrespective of fetal maturity. Elective management of asymptomatic hernias is more controversial and both conservative and operative approaches have been suggested. CONCLUSION Diaphragmatic hernias can cause life-threatening complications in pregnancy. Consideration should be given to operative repair in the second trimester if asymptomatic hernias are identified during pregnancy. If vaginal delivery is attempted in the presence of a hernia, this should only be carried out under closely monitored conditions.
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Affiliation(s)
- Timothyw Eglinton
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
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Barbetakis N, Efstathiou A, Vassiliadis M, Xenikakis T, Fessatidis I. Bochdaleck’s hernia complicating pregnancy: Case report. World J Gastroenterol 2006; 12:2469-71. [PMID: 16688848 PMCID: PMC4088093 DOI: 10.3748/wjg.v12.i15.2469] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk’s gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek’s hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. Postoperative period was uncomplicated. Pregnancy was allowed to continue until 39 wk’s gestation at which time elective cesarean delivery was performed. It is concluded that symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.
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Affiliation(s)
- Nikolaos Barbetakis
- Department of Cardiothoracic Surgery, Geniki Kliniki-Euromedica, Paraliaki Ave and Gravias 2, Thessaloniki, Greece.
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