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Open Access Case report

Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report

Noriaki Tokumoto1, Kazuaki Tanabe1*, Hideki Yamamoto1, Takahisa Suzuki1, Yoshihiro Miyata2 and Hideki Ohdan1

Author Affiliations

1 Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551

2 Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

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Journal of Medical Case Reports 2010, 4:366  doi:10.1186/1752-1947-4-366

Published: 17 November 2010

Abstract

Introduction

Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. Once a Bochdalek hernia has been diagnosed, surgical treatment is necessary to avoid complications such as perforation and necrosis.

Case presentation

We present a 17-year-old Japanese boy with left-upper-quadrant pain for two months. Chest radiography showed an elevated left hemidiaphragm. Computed tomography revealed a congenital diaphragmatic hernia. The spleen and left colon had been displaced into the left thoracic cavity through a left posterior diaphragmatic defect. We diagnosed a Bochdalek hernia. Surgical treatment was performed via a thoracoscopic approach. The boy was placed in the reverse Trendelenburg position and intrathoracic pressure was increased by CO2 gas insufflations. This is a very useful procedure for reducing herniated contents and we were able to place the herniated organs safely back in the peritoneal cavity. The diaphragmatic defect was too large to close with thoracoscopic surgery alone. Small incision thoracotomy was required and primary closure was performed. His postoperative course was uneventful and there has been no recurrence of the diaphragmatic hernia to date.

Conclusion

Thoracoscopic surgery, performed with the boy in the reverse Trendelenburg position and using CO2 gas insufflations in the thoracic cavity, was shown to be useful for Bochdalek hernia repair.