Laparoscopic Repair of Bochdalek Hernia Into Contralateral Thoracic Cavity

Yasoo Sugiura, MD, Keisuke Kubota, MD, PhD, Masayuki Kojima, MD, PhD, Nobuhiro Nitori, MD, PhD, Etsuo Nemoto, MD, PhD, Toshinori Hashizume, MD, PhD, Shizuka Kaseda, MD, PhD, Yoshiaki Sugiura, MD, PhD

Department of Pulmonary and Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, Hadano, Kanagawa, Japan. (Drs Yasoo Sugiura, Nemoto, Hashizume, and Kaseda); Department of Surgery, St. Luke’s International Hospital, Chuou-ku, Tokyo, Japan (Dr Kubota); Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan (Dr Kojima); Department of Gastroenterological Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan (Dr Nitori); Prevention Medical Center, Sanno Hospital and Medical Center, Minato-ku, Tokyo, Japan (Dr Yoshiaki Sugiura).

ABSTRACT

Introduction: Bochdalek hernias in adults rarely become symptomatic. However, once the abdominal organs become incarcerated in Bochdalek hernia, surgery is required to reduce them from the thoracic cavity.

Case Description: We present the case of a 71-year-old woman with continuous chest discomfort and spontaneous epigastralgia. Computed tomography demonstrated that the colon and omentum were herniated into the right thoracic cavity through the posterior mediastinum from a left diaphragm defect. We suspected Bochdalek hernia because upper gastrointestinal series radiography showed that the esophageal hiatus was intact. At first, the hernia was unsuccessfully reduced by colonoscopy. Then laparoscopic repair was performed because the abdominal organs were herniated in the thoracic cavity opposite to the hernial orifice. We succeeded in laparoscopic repair and closure of the orifice by direct suturing and diagnosed this diaphragm hernia as Bochdalek hernia.

Discussion: Surgical repair should be performed immediately after diagnosis to prevent strangulation or perforation. To the best of our knowledge, this is the first report of adult Bochdalek hernia in which abdominal organs were herniated into the opposite side of the hernial orifice.

Key Words: Bochdalek hernia, Laparoscopy, Diaphragm hernia, Thoracic cavity.

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