Early failure of primary repair of a Bochdalek diaphragmatic defect during retroperitoneal liposarcoma resection: a case report

Adult Bochdalek hernia is a rare congenital diaphragmatic defect that may complicate the surgical management of retroperitoneal tumors extending into the thoracic cavity. An 87-year-old woman presented with a 24-cm retroperitoneal liposarcoma protruding into the thoracic cavity through a Bochdalek defect. En bloc tumor resection with left nephrectomy and partial diaphragmatic resection was performed. The 5-cm diaphragmatic defect appeared suitable for tension-free primary closure and was repaired with interrupted nonabsorbable sutures. However, on postoperative day 5, acute intrathoracic herniation of the stomach occurred. Reoperation revealed enlargement of the defect to 8 cm, and mesh reconstruction was performed. Chronic stretching of the diaphragm and involvement of the central tendon likely compromised tissue integrity and contributed to early repair failure. Mesh reinforcement should be considered when diaphragmatic defects appear structurally weakened.