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Case Reports
. 2016 Jun 1;16(1):34.
doi: 10.1186/s12893-016-0145-2.

A case of right-sided Bochdalek hernia incidentally diagnosed in a gastric cancer patient

Satoru Kikuchi  1 , Masahiko Nishizaki  2 , Shinji Kuroda  1 , Shunsuke Kagawa  1 , Toshiyoshi Fujiwara  1
Affiliations
Case Reports

A case of right-sided Bochdalek hernia incidentally diagnosed in a gastric cancer patient

Satoru Kikuchi et al. BMC Surg. .

Abstract

Background: 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.

Case presentation: 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.

Conclusion: 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.

Keywords: Adult; Bochdalek hernia; Congenital diaphragmatic hernia; Laparoscopic surgery; Right-sided.

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Figures

Fig. 1
Fig. 1
a, b Preoperative chest X-ray reveals an elevated right hemidiaphragm
Fig. 2
Fig. 2
a, b Findings from preoperative thoracic and abdominal computed tomography (CT) for gastric cancer. Transverse CT shows the right hepatic lobe in the right inferior intrathoracic area (a: asterisk). On coronal section, the asterisk indicates the right hepatic lobe herniating into the right hemithorax via a diaphragmatic defect (b). c Thoracic and abdominal CT before radiotherapy for cervical cancer. The right hepatic lobe has herniated into the right hemithorax (asterisk), and appears no different in terms of the size of herniated liver compared to the preoperative CT for gastric cancer
Fig. 3
Fig. 3
a, b Laparoscopic view of BH. The right hepatic lobe that had herniated into the thorax cavity is adherent to the remnant diaphragm and covers the diaphragm defect
See this image and copyright information in PMC

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