Indraneil Mukherjee, MD, Aleksandr Demin, DO, Andrey Mironenko, MD, Karen E Gibbs, MD, Zhuo-Qian Zhang, Aleksandra Ogrodnik, MD. Staten Island University Hospital
Introduction: Bochdalek hernias are a rare condition consisting of a postero-lateral diaphragmatic defect. The incidence is reported 0.08–0.45 per 1000 live births. With advent of fetal ultrasound and improvement of technologies, the majority of the cases are diagnosed prenatally or shortly after birth. The cases where large defects are encountered perinatally, systematic approach of repair shortly after the delivery of the infant is undertaken. Large symptomatic Bockdalek hernias are very infrequently found in adults. However, when encountered patient often presents with vague gastrointestinal or respiratory symptoms.
Case Presentation: We present a case of a Giant Bochdalek hernia in a 50-year-old lady with multiple organs within the thoracic cavity presenting as gastric outlet obstruction. We initially suspected this to be a large paraoesophageal hernia causing gastric outlet obstruction. The patient’s symptoms were partially controlled with a Naso-gastric tube. She underwent pre-operative CT Scan, EGD and Upper GI series.
It was confirmed to be a large left sided Bochdalek hernia. We laparoscopically reduced her stomach, colon, omentum, spleen and pancreas. We repaired the 10 x 5 cm defect with interrupted pledgeted nonabsorbable sutures. The repair was reinforced with coated lightweight polypropylene mesh. She recovered well post operatively and is symptom free since.
Discussion: Multiple ways to approach such large defects has been described in various literature. Trans thoracic, peritoneal or a combination of the two has been used. In our search the more recent studies with larger defects favor the minimally invasive transabdominal approach.
Our video validates the feasibility of laparoscopic repair of Bochdalek hernia in an adult and details the nuances of such repair. We propose this should be the ideal approach to management of symptomatic Giant Bochdelak hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93215
Program Number: V096
Presentation Session: Exhibit Hall Theater Video Session IV
Presentation Type: EHVideo