Lochman Petr, Hůlek Michal, Dušek Tomáš
Department of Military Surgery, University of Defence, Military Faculty of Medicine, Hradec Kralove, CZE.
Department of Surgery, University Hospital, Hradec Kralove, CZE.
Cureus. 2024 May 4;16(5):e59635. doi: 10.7759/cureus.59635. eCollection 2024 May.
Bochdalek's hernia is the most common congenital malformation of the diaphragm with a defect in its posterolateral part. Its clinical manifestation in adulthood is rare. It is often an incidental finding, and its diagnosis may be challenging. A high index of suspicion is necessary, especially in cases presenting with cardiopulmonary or abdominal symptoms and an ambiguous finding on the initial chest X-ray. We present a case of an asymptomatic 50-year-old male patient with a bulky left-sided Bochdalek's hernia. Surgical treatment was indicated, and a direct suture of the defect after reduction of the herniated greater omentum, transverse colon, and tail of the pancreas was performed from the upper midline laparotomy. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. The management of adult patients with these kinds of hernias in both acute and chronic settings is discussed, and some recommendations are mentioned to minimize unnecessary pitfalls.
博赫达勒克疝是最常见的先天性膈肌畸形,其在膈肌后外侧部分存在缺损。它在成年期的临床表现较为罕见。通常是偶然发现,其诊断可能具有挑战性。必须保持高度的怀疑指数,尤其是对于出现心肺或腹部症状且初始胸部X线检查结果不明确的病例。我们报告一例50岁无症状男性患者,患有巨大的左侧博赫达勒克疝。由于有手术指征,通过上腹部正中切口剖腹手术,在将疝出的大网膜、横结肠和胰尾回纳后对缺损进行了直接缝合。术后过程顺利,患者于术后第5天出院。本文讨论了成年患者在急性和慢性情况下此类疝的处理,并提及了一些建议以尽量减少不必要的失误。