From the Guidelines
Bochdalek hernia in adults is a rare and potentially life-threatening condition that requires prompt diagnosis and treatment.
Significance of Bochdalek Hernia in Adults
The significance of Bochdalek hernia in adults lies in its potential to cause severe complications, such as:
- Incarceration, strangulation, or perforation of abdominal organs
- Respiratory failure due to compression of the lungs
- Cardiac tamponade due to compression of the heart
- The condition can be asymptomatic for decades before becoming symptomatic, making diagnosis challenging 1.
Diagnosis and Treatment
Diagnosis of Bochdalek hernia in adults can be difficult due to its rarity and nonspecific symptoms.
- CT scan of the chest and abdomen is the gold standard for diagnosing complicated diaphragmatic hernia, with a sensitivity and specificity of 14-82% and 87%, respectively 1.
- Laparoscopic repair is the preferred treatment option for stable patients with complicated diaphragmatic hernias, while open repair is considered necessary in unstable patients 1.
Clinical Presentation
The clinical presentation of Bochdalek hernia in adults can vary, but common symptoms include:
- Gastrointestinal symptoms, such as gastric obstruction, strangulation, volvulus, incarceration, dysphagia, and bleeding
- Respiratory symptoms, such as dyspnea and respiratory failure
- Abdominal pain and tenderness
- The natural history of traumatic diaphragmatic injury with hernia formation can be described in three phases: acute, latent, and obstructive 1.
From the Research
Significance of Bochdalek Hernia in Adults
The significance of Bochdalek hernia in adults is highlighted by its rare occurrence and potential for severe complications. Some key points to consider include:
- Bochdalek hernia is a congenital diaphragmatic hernia that is predominantly diagnosed in the pediatric population, but can also occur in adults 2, 3, 4, 5, 6
- The hernia can contain various organs, such as the spleen, kidney, and stomach, which can become twisted or obstructed, leading to severe symptoms 2, 3, 5
- Symptoms of Bochdalek hernia in adults can vary from abdominal pain to chest discomfort, and diagnosis can be challenging due to the rarity of the condition and the non-specific nature of the symptoms 2, 3, 4, 5, 6
- Imaging tests, such as CT scans, are essential for accurate diagnosis and timely surgical intervention is crucial for preventing life-threatening outcomes 2, 3, 4, 5, 6
Complications and Treatment
Some potential complications and treatment options for Bochdalek hernia in adults include:
- Gastric volvulus, where the stomach twists on itself, leading to potentially serious symptoms such as severe abdominal pain and vomiting 2
- Bowel obstruction, which can be life-threatening if not treated promptly 3
- Surgical repair, which can be performed using open or laparoscopic techniques, and may involve the use of a synthetic patch to close the defect 4, 6
- Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach that can be used to repair Bochdalek hernias in adults, with good and lasting results 4
Diagnosis and Management
Diagnosis and management of Bochdalek hernia in adults can be challenging due to the rarity of the condition and the non-specific nature of the symptoms. Some key points to consider include:
- The use of CT scans and other imaging tests to confirm the diagnosis and plan surgical intervention 2, 3, 4, 5, 6
- The importance of timely surgical intervention to prevent life-threatening outcomes 2, 3, 4, 5, 6
- The need for a multidisciplinary approach to management, involving thoracic surgeons, upper gastrointestinal surgeons, and other specialists as needed 4