de Brauw, LM

Pannekoek, Anne

Roest, Manon

Tielbeek, JAW

van Delft, EAK

The Bochdalek hernia is a rare congenital defect in the posterolateral diaphragm, often presented at pediatric age with symptoms such as respiratory complaints due to mechanical obstruction of the intestines. Organs as the kidney, spleen and pancreas tend to herniate usually through the left hemidiaphragm. We present a case of a right sided Bochdalek hernia with an obstructed sigmoid colon in an adult. During my stay I had faith in the surgeon and nurses. They informed me well throughout the whole process and the surgeon was sincerely involved. I felt comfortable during my stay in the hospital and my recovery was quick

Tilburg University Repository

    Tilburg UniversityLaparoscopic repair of a right-sided Bochdalek hernia with sigmoid in an adultPannekoek, Anne; Roest, Manon; van Delft, EAK; Tielbeek, JAW; de Brauw, LMPublished in:World Journal of Surgery and Surgical ResearchPublication date:2022Document VersionPublisher's PDF, also known as Version of recordLink to publication in Tilburg University Research PortalCitation for published version (APA):Pannekoek, A., Roest, M., van Delft, EAK., Tielbeek, JAW., & de Brauw, LM. (2022). Laparoscopic repair of aright-sided Bochdalek hernia with sigmoid in an adult: A case report. World Journal of Surgery and SurgicalResearch, 5(1), Article 1409. https://www.surgeryresearchjournal.com/open-access/laparoscopic-repair-of-a-right-sided-bochdalek-hernia-with-sigmoid-in-9320.pdfGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            • Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            • You may not further distribute the material or use it for any profit-making activity or commercial gain            • You may freely distribute the URL identifying the publication in the public portalTake down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Download date: 26. Sep. 2023Remedy Publications LLC., | http://surgeryresearchjournal.comWorld Journal of Surgery and Surgical Research2022 | Volume 5 | Article 14091Laparoscopic Repair of a Right-Sided Bochdalek Hernia with Sigmoid in an Adult: A Case ReportOPEN ACCESS *Correspondence:L Maurits de Brauw, Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands,E-mail: mdebrauw@spaarnegasthuis.nlReceived Date: 01 Sep 2022Accepted Date: 20 Sep 2022Published Date: 26 Sep 2022Citation: Pannekoek A, Roest MJ, van Delft EAK, Tielbeek JAW, de Brauw LM. Laparoscopic Repair of a Right-Sided Bochdalek Hernia with Sigmoid in an Adult: A Case Report. World J Surg Surgical Res. 2022; 5: 1409.Copyright © 2022 de Brauw LM. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Case ReportPublished: 26 Sep, 2022AbstractThe Bochdalek hernia is a rare congenital defect in the posterolateral diaphragm, often presented at pediatric age with symptoms such as respiratory complaints due to mechanical obstruction of the intestines. Organs as the kidney, spleen and pancreas tend to herniate usually through the left hemidiaphragm. We present a case of a right sided Bochdalek hernia with an obstructed sigmoid colon in an adult. During my stay I had faith in the surgeon and nurses. They informed me well throughout the whole process and the surgeon was sincerely involved. I felt comfortable during my stay in the hospital and my recovery was quick.Keywords: Bochdalek hernia; Laparoscopic repair; HemidiaphragmPannekoek A1, Roest MJ1, van Delft EAK1, Tielbeek JAW2 and de Brauw LM1*1Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands2Department of Radiology, Spaarne Gasthuis Hoofddorp, NetherlandsIntroductionThe Bochdalek hernia is a rare congenital defect in the posterolateral diaphragm, often presented at pediatric age with symptoms such as respiratory complaints due to mechanical obstruction of the intestines. Organs as the kidney, spleen and pancreas tend to herniate usually through the left hemidiaphragm [1,2]. We present a case of a right sided Bochdalek hernia with an obstructed sigmoid colon in an adult.Case PresentationA 68-year-old woman with a history of constipation and anterior vaginal wall repair was presented at the emergency department with pain in the right lumbar region, migrating to the shoulder. Along with a cramping pain, she had the urge to move. Defecation was absent for seven days despite the use of laxatives whilst flatulence was present. Nausea occurred without vomiting. There was no relevant medical history or medication use. The blood pressure was 171/84 mmHg, with a heart rate of 66/min, and temperature was normal. Physical examination revealed abdominal distension, tympanic percussion, hyperactive bowel sounds and tenderness in the upper right lumbar region. No scars of previous operations were visible. Laboratory findings showed a C-reactive protein of 8 mg/L and leukocytes of 6.4 × 109/L.InvestigationsThe patient was examined with an abdominal Computed Tomography (CT). The CT revealed a mechanical ileus due to distal colonic obstruction most probably caused by a herniated dolichosigmoid colon through an opening in the right hemidiaphragm (Figure 1). There were no signs of intestinal perforation or necrosis.DiagnosisA mechanical ileus of the colon due to a Bochdalek hernia of the sigmoid colon was diagnosed.TreatmentAt the emergency room, the patient received paracetamol, morphine and gastric decompression via tube. The patient was admitted to emergency surgery.During a diagnostic laparoscopy, the Bochdalek defect in the right hemidiaphragm was found with incarcerated sigmoid colon. The diaphragm was opened using diathermia in order to reduce the hernia. The mobilized colon and omentum were well perfused. The hernia sac was dissected and the diaphragm was closed with non-resorbable sutures and an only 10 cm coated polypropylene mesh, which was fixed to the diaphragm using tackers.Pannekoek A, et al., World Journal of Surgery and Surgical Research - General Surgery2022 | Volume 5 | Article 14092Remedy Publications LLC., | http://surgeryresearchjournal.comOutcome and follow-upThe patient recovered well following the ‘Enhanced Recovery after Surgery’ protocol, no adverse events took place. The mechanical ileus resolved and at the first postoperative day all catheters were removed. On the third day postoperatively, the patient was discharged. Further recovery was uneventful.DiscussionThis is probably the first case of an adult patient presenting with an ileus due to herniation of the sigmoid colon through a right sided Bochdalek hernia. Cases of a Bochdalek hernia are rare, especially in adults, with an incidence of 0.17% [2]. In adults, only 27% of these hernias are found in the right hemidiaphragm. When presenting, the transverse colon is most frequently involved in the herniation.Early diagnosis and surgical laparoscopic repair are important for this group of patients considering the mechanical ileus will not resolve by conservative therapy. Treatment is often surgically: By laparoscopy, by VATS, or by open repair. Recurrence rates for patch repair are higher than for primary repairs, 27% to 41% vs. 4% to 13%, respectively [1].The Bochdalek hernia is a congenital defect in the diaphragm. Formation of the diaphragm normally takes place by closing of the pleuroperitoneal communication at week 8 of gestation. The right canal closes before the left canal. Hereby, 85% of all Bochdalek hernias are left-sided. At the pediatric age, patients present often with respiratory symptoms. Herniation of the abdominal organs into the thorax may cause mechanical compression of the developing lungs. Sometimes, this results in lung hypoplasia. Congenital diaphragmatic hernias occur in 1 in 2000/3000 births. Of those, about 70% to 75% is a posterolateral hernia, called the Bochdalek hernia [1,3].The exact etiology is unknown. Both genetic and environmental factors may contribute to this defect. In approximately 30% of Bochdalek hernias, a genetic cause is found. Gene copy number variants, chromosome irregularities and DNA sequence variants are found. Often, with genetic causes like these, multisystem anomalies are found as well [1]. Bochdalek hernias and other congenital diaphragmatic hernias are associated with pulmonary, intestinal and cardiac defects like intestinal malrotations [4], the tetralogy of Fallot [5], hypoplasia of the liver [6] or lungs [7] and Meckel’s diverticulum [8].Patient’s Perspective“I had persisting complaints of abdominal pain and even pain in my shoulder. After already two reassessments at the emergency room, I was sent home again with laxatives. I do understand why, since there was no fever or elevated infection parameters. After three more days my general practitioner sent me to the hospital for reassessment and eventually admission.”“During my stay I had faith in the surgeon and nurses. They informed me well throughout the whole process and the surgeon was sincerely involved. I felt comfortable during my stay in the hospital and my recovery was quick.”References1. Gue RS, Winkler L. Bochdalek Hernia. 2020.2. Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of incidental Bochdalek’s hernia in a large adult population. Am J Roentgenol. 2001;177(2):363-6.3. Machado NO. Laparoscopic repair of Bochdalek diaphragmatic hernia in adults. N Am J Med Sci. 2016;8(2):65-74.4. Salústio R, Nabais C, Paredes B, Sousa FV, Porto E, Fradique C. Association of intestinal malrotation and Bochdalek hernia in an adult: A case report. BMC Res Notes. 2014;7:296.5. Arora Y, Devagourou V, Kar T. Tetralogy of Fallot with congenital diaphragmatic hernia with right lung aplasia a rare entity. Indian J Thorac Cardiovasc Surg. 2020;36(5):538-40.6. Zenda T, Kaizaki C, Mori Y, Miyamoto S, Horichi Y, Nakashima A. Adult right-sided Bochdalek hernia facilitated by coexistent hepatic hypoplasia. Abdom Imaging. 2000;25(4):394-6.7. Alam A, Chander BN. Adult Bochdalek Hernia. Med J Armed Forces India. 2005;61(3):284-6.8. Basani L, Aepala R, Reddy BM M. Congenital diaphragmatic hernia, Meckel's diverticulum and malrotation in a 3-month-old infant. Afr J Paediatr Surg. 2016;13(1):47-9.Figure 1: Oblique coronal CT image shows a defect of 5 cm in the right posterior diaphragm with a herniating sigmoid loop into the right hemithorax.

English

Laparoscopic repair of a right-sided Bochdalek hernia with sigmoid in an adult:A case report

https://pure.uvt.nl/ws/files/75857884/laparoscopic-repair-of-a-right-sided-bochdalek-hernia-with-sigmoid-in-9320_2_.pdf

Laparoscopic repair of a right-sided Bochdalek hernia with sigmoid in an adult:A case report

Abstract

Similar works

Full text

Available Versions

Tilburg University Repository