AI Article Synopsis
- Right-sided Bochdalek hernia (BH) is a rare problem where parts of the belly push into the chest due to a weak spot in the diaphragm, and only a few cases in adults have been treated so far.
- A 50-year-old woman had a serious case where her intestines got stuck (strangulated) and had to be treated quickly with surgery, but they faced complications because of "loss of domain."
- It’s important to fix BH quickly to avoid serious health issues, and there are different ways to do the surgery, especially if there's a risk of complications after the repair.
Article Abstract
Introduction: Right-sided Bochdalek hernia (BH) is a rare developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax. To date only 44 reported cases of right-sided BH have been surgically managed in adults in literature. We report one additional case of right-sided BH with loss of Domain. "Loss of domain" (LOD) is a term used commonly in the hernia literature to describe the distribution of abdominal content between the hernia and residual abdominopelvic cavity. After repairing hernias with significant LOD, serious physiological complications can arise.
Methods: PubMed and Cochrane bibliographical databases were searched (last search: February 2022) for studies concerning BH.
Case Presentation: We report the case of a 50-year-old woman whose right-sided diaphragmatic hernia strangulated loops of small bowel and who was thus treated via urgent laparoscopy. After reduction of the intrathoracic contents we were unable to primarily close the midline fascia.We performed a staged abdominal wall reconstruction as the chronicity of the hernia led to loss of intra-abdominal domain.
Discussion: Bochdalek hernia (BH) is the most common type of congenital diaphragmatic hernia and is usually leftsided. It typically presents in neonates and diagnosis in adults is a rarity. Various surgical repair options include open surgery, laparoscopic repair, thoracoscopic approach and robotic transthoracic approaches.
Conclusion: BH should be managed timely regardless of its symptoms to avoid future complications. The closure of the defect can be done by different methods. When, after diaphragmatic hernia repair, it is suspected that the herniated viscera have lost their domain, it is preferable to use a Temporary Abdominal Closure to prevent compartment syndrome.
Key Words: Bochdalek hernia with loss of Domain, Bochdalek hernia in adults, Non traumatic Bochdalek hernia, Right-sided diaphragmatic hernia.
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