Bochdalek hernia in an adult: two case reports and a review of perioperative cardiopulmonary complications

Abstract

Background: 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.

Case presentation: 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.

Conclusions: 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.

Keywords: Adult; Bochdalek hernia; Pulmonary complications.

Fig. 1

Chest X-ray showing colon gas and a nasogastric tube above the left diaphragm. Arrows showed the herniated colon (a). Coronal CT imaging revealed herniation of the stomach, pancreas, spleen, and colon (b)

Fig. 2

CT imaging 10 years before surgery showed modestly prolapsed viscera (colon, spleen, and pancreas)

Fig. 3

After reducing the herniation. The hernia orifice was 7 cm, and there was no hernia sac

Fig. 4

Chest X-ray 5 h after surgery showing a fully expanded left lung without re-expansion pulmonary edema

Fig. 5

Chest X-ray showing the dilated colon above the right diaphragm (a). CT scan showing strangulation of the colon with some ascites fluid in a sac (b)