Dagnostics and surgical treatment of Bochdalek hernia in adults

Objective. To estimate the incidence, diagnostic possibilities and surgical strategy for Bochdalek hernias in adults. Material and methods. Bochdalek hernias were diagnosed in 7 (9.2%) out of 76 patients with diaphragmatic hernias (age 49—63 years). The left-sided hernia was diagnosed in 5 patients (71.4%), right-sided — 1 patient, bilateral hernia — 1 patient. Results. The disease was diagnosed during routine X-ray examination in 5 cases. Two patients complained of breathlessness and abdominal pain. Computed tomography revealed displacement of retroperitoneal fat (n=6), kidney (n=3), adrenal gland (n=2), pancreas (n=1) and colon (n=1) towards the diaphragm. In one case, ureter angulation caused kidney dysfunction. Mean dimension of hernial orifice was 7.9±3.1 cm. Two patients without any clinical and functional manifestations did not require surgery. In 1 case, surgery was contraindicated due to cardiac comorbidities. The fourth one refused surgery. Three (42%) patients underwent surgery. In the first case, diaphragm repair was performed through the right-sided thoracic approach in combination with nephrectomy because of kidney dysfunction. In the second case, we performed left-sided thoracotomy, in one case — video-assisted thoracoscopy. One patient died from recurrent mesenteric thrombosis accompanied by bowel necrosis after nephrectomy. Conclusion. Bochdalek hernias in adults are most often right-sided and contain fat tissue. Surgical treatment is required in case of displacement of internal organs, clinical manifestations, compression and functional disturbances.