Hiatal Hernia to Bochdalek: A Case Report

Abstract

Hiatal hernias and Bochdalek hernias are two types of diaphragmatic hernias that present with similar symptoms. However, they differ in their etiology and anatomical location. In this case study, we present the clinical features and management of a patient who presented with symptoms suggestive of a hiatal hernia but was later diagnosed with a Bochdalek hernia. Our case has a 64-year-old female patient who presented with chronic obstructive pulmonary disease, hypertension, and gastroesophageal reflux disease. During her pulmonologist-ordered imaging, which included a CT scan, the report showed a large 8 cm hiatal hernia. Due to her condition, she was scheduled for a hiatal hernia repair, along with a transoral incisionless fundoplication (TIF) procedure. During the operation, a large defect was seen in the left hemidiaphragm with herniation of bowel loops into the chest cavity. It was confirmed to be a Bochdalek hernia. The surgeon proceeded to continue the laparoscopic repair, pulling the bowel back into the abdomen, and using the falciform ligament of the liver to buttress the diaphragm. The surgery was a success, and the patient had no postoperative complications. This case serves as a reminder that a high degree of suspicion is required for the diagnosis of Bochdalek hernias, especially in patients with atypical presentations or imaging findings suggestive of an alternative diagnosis, such as a hiatal hernia. The patient had chronic symptoms of various gastrointestinal and respiratory comorbidities, which should serve as a caution for clinicians to carefully consider the possibility of a Bochdalek hernia when evaluating patients with similar symptoms. This case study also illustrates the success of a minimally invasive surgical approach for repairing a Bochdalek hernia, with the use of laparoscopic techniques and using falciform ligament to support the diaphragm.

Keywords: adult bochdalek hernia; ards; bochdalek; bochdalek hernia; hiatal hernia; misdiagnosis.

Figure 1. From top left, clockwise: contents (stomach, small intestines) being evacuated from the hernial cavity, buttress stitching of the hernia in stages.