Surgical repair of large adult Bochdalek hernia: case series and literature review

Abstract

Introduction: Bochdalek hernia is a rare congenital diaphragmatic defect, typically diagnosed in infancy. Adult presentation is uncommon, and management remains debated, particularly in asymptomatic cases. This report presents two adult cases successfully treated with surgical repair, contributing to the limited literature on adult Bochdalek hernias.

Presentation of case: A 20-year-old male, with no prior medical history, was incidentally found to have a left posterolateral diaphragmatic defect (5 × 7 cm) containing small bowel, splenic flexure of the colon, and the left kidney. Laparoscopic repair was attempted but converted to open surgery due to limited visualization and tension. Postoperatively, he developed a left pneumothorax and pneumoperitoneum requiring chest tube placement and was discharged on day six. A 43-year-old female with previous gastric banding presented with recurrent nausea, vomiting, and abdominal pain. Imaging revealed a large left diaphragmatic hernia (12 × 6 cm) containing stomach and bowel segments. She underwent emergency open repair. Postoperative recovery was complicated by a minimal left pneumothorax, which resolved, and she was discharged on day nine.

Discussion: Adult Bochdalek hernias are rare and may be discovered incidentally or present with acute symptoms. Surgical repair is recommended to prevent complications, and laparoscopic approaches may require conversion to open repair in cases of large defects or high tension.

Conclusion: Early recognition and timely surgical intervention are crucial for adult Bochdalek hernia, even in asymptomatic patients. These cases highlight effective management strategies and enhance understanding of this rare adult presentation.

Keywords: adult; bochdalek hernia; case report; diaphragmatic hernia; surgical repair.

Figure 1

(A) Chest x-ray, AP view. Showing a large left diaphragmatic hernia with abdominal contents in the left hemothorax (arrows), and a mediastinal shift towards the right side. (B) Preoperative CT scan of the chest, abdomen, and pelvis with contrast, coronal view. Showing a left posterior defect on the left hemidiaphragm with herniation of small bowel loops, splenic flexure of the colon and left kidney with a hernia defect measuring about 5 × 7 centimeter (Arrow; splenic flexure of the colon. X; small bowels, *; left kidney).

Figure 2

Postoperative CT scan of the chest, abdomen, and pelvis with contrast, coronal view. Showing reduced previously herniated abdominal organ into the left hemidiaphragm (arrow).

Figure 3

(A) Chest x-ray, PA view. Showing large left diaphragmatic hernia with obstruction, demonstrated by herniated small bowel loops with air-fluid levels (arrows) (B) CT scan of the chest, abdomen, and pelvis with contrast, coronal view. Showing large left diaphragmatic hernia containing a dilated stomach, dilated small bowel loop and collapsed small bowel loops. (L.;liver, P.;pancreas, St.;stomach, Col.;colon, D.S.B; dilated small bowels, C.S.B.; collapsed small bowels).

Figure 4

Postoperative chest x-ray, AP view. Showing reduced previously herniated abdominal organ (arrow).