• bochdalek's hernia
• congenital diaphragmatic hernia
• congenital heart disease
• diaphragm
• ileo-caecal appendix
• mesh repair
• patent ductus arteriosus
• pulmonary hypoplasia
• surgical ligation of patent ductus arteriosus
• • bhende-pathak hernia

• Abnormal liver morphology
• Adult
• Bochdalek hernia
• Case report
• Laparoscopic and thoracoscopic repair
• Liver prolapse
• Right-sided

• Bochdalek hernia
• abdominal surgery
• congenital hernia
• diaphragmatic hernia
• thoracic surgery
• thoracotomy

The thoracic kidney is the rarest form of renal ectopia. Furthermore, it is usually asymptomatic and discovered incidentally. It is seen as a mass in the posterior mediastinum or juxta-diaphragmatic on chest radiography. A computed tomography scan or magnetic resonance imaging is usually needed for a definitive diagnosis. The thoracic kidney typically exits the retroperitoneal space through the foramen of Bochdalek.

Right-sided Bochdalek hernia is a mostly congenital condition of the diaphragm caused by a persistence of the pleuroperitoneal cavity and a rare disease in adults. As it often presents as an emergent situation, urgent diagnostics and surgical intervention are essential to reduce morbidity and mortality rates. Choosing the right surgical approach (abdominal, thoracic, or a combination of both) can be very challenging for clinicians. Here, we report a case of a 40-year-old woman, who presented with severe abdominal pain and tachypnoea. Imaging revealed a right-sided Bochdalek hernia. Emergency laparotomy was performed followed by reduction of hernia content, right-sided hemicolectomy, and side-to-side anastomosis from the ileum to the transverse colon due to intestinal ischemia and intrathoracic bowel perforation. The post-operative course was complicated by a pleural empyema. Therefore, the patient underwent thoracotomy. One year after surgical repair the patient had no recurrence. Here, we discuss feasible approaches for the surgical management of complicated Bochdalek hernias.

• Bochdalek hernia
• hernia
• mesh
• repair
• suture
• thoracic complication

• Bochdalek hernia
• Laparoscopy
• Thoracoscopy

Une patiente de 45 ans reçue en consultation pour des douleurs isolées de l´hypochondre droit irradiant dans le dos, évoluant depuis plusieurs années. Elle n´avait pas d´antécédents médicaux. L'examen physique était sans particularités. La tomodensitométrie retrouvait une hernie diaphragmatique droite (hernie de Bochdalek) avec issue d´une partie du foie dans le thorax. La patiente a eu une cure herniaire par voie robotique. Les suites opératoires ont été simples. La patiente est actuellement à un an post-opératoire sans récidive. La hernie de Bochdalek avec issue hépatique en intrathoracique chez un adulte est une entité rare qui peut être traitée par voie robotique.

• Bochdalek hernia
• a case report
• liver herniation
• robotic surgery

Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias.

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed.

Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented.

This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed.

The online version contains supplementary material available at 10.1007/s10029-021-02445-1.

• Algorithm
• Bochdalek hernia
• Hernia
• Mesh
• Repair
• Suture

• Adult diaphragmatic hernia
• Bochdalek hernia
• Surgery

• empyema
• gastrointestinal surgery
• general surgery
• radiology
• surgery

Bochdalek hernia in an adult is very rare and often needs an immediate surgical repair for the herniation. Although its etiology and surgical techniques have frequently been reported, perioperative complications, especially cardiopulmonary problems, remain unknown. We reported two adults with Bochdalek hernia and reviewed the published literatures with a focus on these issues.

We experienced two adult cases of Bochdalek hernia with gastrointestinal strangulation. One case had massive herniation of the stomach, colon, spleen, and pancreas in the left chest, causing repeated vomiting. The other had a right-side hernia with strangulation of the colon. We successfully performed emergency repairs of these diaphragmatic hernias without any postoperative complications.

Our literature review revealed that life-threatening cardiopulmonary complications, such as empyema or cardiac arrest caused by the tamponade effect of the herniated viscera, sometimes occurred in patients with Bochdalek hernia. These complications were found in Bochdalek hernia with gastrointestinal strangulation.

• Adult
• Bochdalek hernia
• Pulmonary complications

• appendix
• diaphragmatic hernia
• hernia
• perforated appendicitis

• Bochdalek hernia
• minimally invasive surgery

• bochdalek hernia
• congenital diaphragm defect
• congenital hernia
• diaphragm
• hiatal hernia

A 41-year-old man with a medical history of chronic back pain, seizure disorder, alcohol and tobacco abuse presented with acute shortness of breath. Chest X-ray showed a large right-sided pleural effusion. Pleural fluid analysis was significant for an elevated amylase level, suggestive of pleural effusion secondary to pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) revealed a persistent right-sided pleural effusion in connection with a right pararenal space fluid collection via a Bochdalek hernia. An endoscopic ultrasound found hyperechoic strands and foci, and pancreatic parenchyma consistent with chronic pancreatitis, as well as a pseudocyst in the pancreatic head. A chest tube was ultimately placed to continuously drain the pleural effusion. The patient was discharged and was referred to gastroenterology for outpatient follow-up. This case illustrates a rare presentation of chronic pancreatitis with a Bochdalek hernia as a right-sided pleural effusion in a patient who was previously asymptomatic.

• Adult
• Hernias, Diaphragmatic, Congenital/complications
• Humans
• Male
• Pancreatitis, Chronic/complications
• Pleural Effusion/etiology

• Bochdalek hernia
• Congenital diaphragmatic hernia (CDH)
• Morgagni hernia
• diaphragmatic approach
• video assisted thoracoscopic surgery (VATS)

• Bochdalek hernia
• Diaphragmatic hernia

Bochdalek hernia (BH) can be a life-threatening condition in infants. Approximately 85.3% of newborns with a BH are immediately at high risk and have a high mortality rate due to respiratory insufficiency [Kocakusak et al.: Hernia 2005;9: 284–287]. However, BH is almost asymptomatic in adults and discovered only incidentally [Wilkins et al.: Clin Imaging 1994;18: 224–229]. Complicated BH in adults might present with visceral incarceration and lethal complications. Upper gastrointestinal bleeding and acute pancreatitis are rarely reported in the literature as complications of BH in adults. Here we report the case of a 42-year-old male who presented with upper gastrointestinal bleeding and acute pancreatitis. He was found to have abdominal visceral organ herniation to the posterior right thoracic cavity. His diagnosis was achieved early and with a close follow-up, we succeeded in stabilizing the patient's condition. Then he was subjected to reconstructive thoracotomy for hernial repair and restoring abdominal viscera.

• Acute pancreatitis
• Bochdalek hernia
• Hematemesis
• Upper gastrointestinal bleeding

• Congenital diaphragmatic hernia
• Diaphragmatic rupture
• Emergency surgery
• Laparotomy
• Mesh
• Thoracotomy

• Aged
• Barium Sulfate/therapeutic use
• Diaphragm/injuries
• Diaphragm/surgery
• Female
• Hernia, Diaphragmatic, Traumatic/complications
• Hernia, Diaphragmatic, Traumatic/surgery
• Hernias, Diaphragmatic, Congenital/complications
• Hernias, Diaphragmatic, Congenital/surgery
• Humans
• Intestinal Obstruction/complications
• Male
• Middle Aged
• Radiography/methods
• Rupture/diagnostic imaging
• Rupture/surgery
• Tomography, X-Ray Computed/methods

An 89‐year‐old woman was admitted to our hospital because of dyspnea following abdominal pain and vomiting. According to chest computed tomography findings, a diagnosis of acute respiratory failure due to right‐sided Bochdalek hernia was made.

Emergency laparotomy revealed that a bowel loop from the terminal ileum to the transverse colon had herniated into the right thoracic cavity through the foramen of Bochdalek. The herniated organs were reduced to the abdominal cavity and the foramen was repaired by direct suturing. The patient had good recovery and was discharged 78 days later.

Bochdalek hernias in elderly patients are rare, but may be complicated by strangulation of the herniated organ. This should be taken into account by acute care physicians. To prevent this fatal complication, regardless of symptoms, surgical treatment may be essential as soon as a diagnosis of adult Bochdalek hernia is made.

• Acute respiratory failure
• Bochdalek hernia
• adult
• congenital diaphragmatic hernia
• right side

• Bochdalek
• Hepatic vein
• Liver herniation
• Right diaphragmatic hernia

Bochdalek hernia (BH) is generally congenital, presenting with respiratory distress. However, this pathology is rarely detected in adults. Some adult cases of BH present with symptoms attributed to the hernia, but incidental detection of BH is increasing among asymptomatic adults due to advances in imaging modalities. This report presents the management of incidental BH patients detected in the preoperative period of gastric cancer.

An asymptomatic 76-year-old woman was diagnosed with advanced gastric cancer during follow-up after radiotherapy for uterine cervical cancer. Computed tomography (CT) was performed to exclude metastatic gastric cancer, incidentally detecting right-sided BH. We planned distal gastrectomy with lymph node dissection for gastric cancer and simultaneous repair of BH using a laparoscopic approach. We performed laparoscopic gastrectomy for gastric cancer and investigated the right-sided BH to assess whether repair during surgery was warranted. Herniation of the liver into the right hemithorax was observed, but was followed-up without surgical repair because the right hepatic lobe was adherent to the remnant right anterior hemidiaphragm and covered the huge defect in the right hemidiaphragm. No intra- or postoperative pneumothorax was observed during pneumoperitoneum.

Regardless of symptoms, repair of adult BH is generally recommended to prevent visceral incarceration. However, BH in asymptomatic adults appears to be more common than previously reported in the literature. Surgeons need to consider the management of incidental BH encountered during thoracic or abdominal surgery.

• Adult
• Bochdalek hernia
• Congenital diaphragmatic hernia
• Laparoscopic surgery
• Right-sided

• Bochdalek hernia (BH)
• congential diaphragmatic hernia (CDH)
• laparoscopic repair

• Abdominal Pain/diagnosis
• Abdominal Pain/etiology
• Abdominal Pain/therapy
• Acute Pain/diagnosis
• Acute Pain/etiology
• Acute Pain/therapy
• Aged, 80 and over
• Choledocholithiasis/complications
• Choledocholithiasis/diagnosis
• Choledocholithiasis/therapy
• Female
• Hernias, Diaphragmatic, Congenital/complications
• Hernias, Diaphragmatic, Congenital/diagnosis
• Hernias, Diaphragmatic, Congenital/therapy
• Humans
• Incidental Findings
• Tomography, X-Ray Computed

An extremely rare adult case that underwent surgery for ileus caused by Bochdalek hernia associated with Chilaiditi’s syndrome is presented. A 65-year-old woman complaining of upper abdominal pain presented to our hospital. Abdominal plain radiography showed increased intestinal gas, and computed tomography (CT) showed the transverse colon located above the right lobe of the liver, representing Chilaiditi’s sign. She was diagnosed as having ileus and treated with decompression therapy by a nasoenteric tube. After hospitalization, the patient developed dyspnea, and CT showed intestinal herniation into the right thoracic cavity. She was diagnosed as having strangulated ileus caused by Bochdalek hernia. An emergent laparotomy was performed, and it showed a hole of 5 cm in diameter at the right hemi-diaphragm. The transverse colon was incarcerated through the hole, it was pulled back to the abdominal cavity, and a right hemicolectomy was performed because of necrotic changes. A small part of the liver was also herniated into the right thoracic cavity, and it was returned to the abdominal cavity. The defect in the diaphragm was closed by direct suture. Although the patient developed an abscess in the thoracic cavity postoperatively, she improved with antibiotic therapy and was discharged 2 months after the operation.

• Bochdalek hernia
• Chilaiditi's syndrome
• In adults
• Strangulated ileus

• Adult
• Bochdalek hernia
• atypical
• right-sided

• Autopsy
• Hernias, Diaphragmatic, Congenital/diagnostic imaging
• Hernias, Diaphragmatic, Congenital/pathology
• History, 17th Century
• Humans
• Male
• Middle Aged
• Mummies/diagnostic imaging
• Republic of Korea
• Tomography, X-Ray Computed

• Colon
• Laparoscopic repair
• Right kidney
• Right-sided Bochdalek hernia

• congenital diaphragmatic hernia
• obstructive jaundice
• bochdalek hernia

• Female
• Hernia, Diaphragmatic/complications
• Hernia, Diaphragmatic/diagnostic imaging
• Hernia, Diaphragmatic/surgery
• Hernias, Diaphragmatic, Congenital
• Humans
• Jaundice, Obstructive/etiology
• Tomography, X-Ray Computed
• Young Adult

Congenital diaphragmatic hernia (CDH) is described as (1) failure of diaphragmatic closure at development, (2) presence of herniated abdominal contents into chest and (3) pulmonary hypoplasia. Usually, pleural space is drained urgently when there is respiratory distress and radiological appearance of mediastinal shift. We present a case of a 5-month-old baby, diagnosed as tension pneumothorax and treated with chest drain insertion. CDH was the intraoperative diagnosis.

• Chest tube
• congenital diaphragmatic hernia
• pneumothorax

Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

Bochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood - the clinical manifestation of symptoms and diagnosis in adults is extremely rare. There are fewer than 20 cases of right-sided Bochdalek hernia reported in adults in the literature.

We review a case of a 38-year-old woman with a right-sided Bochdalek hernia who was experiencing abdominal pain and pleural effusion. The diagnosis of Bochdalek hernia was made by chest X-ray and computed tomography. The right lobe of the liver and flexura hepatica of the colon were herniated into the thorax cavity. The hernia was treated via thoracotomy assisted with laparoscopy and she made an uneventful recovery.

We report a rare case of a right-sided Bochdalek hernia for which our patient was treated successfully. Even though rare, this disorder should be recognised, examined and treated appropriately to avoid complications.