BOCHDALEK’S HERNIA IN ADULTS: A CASE REPORT

Abstract

Вackground. Bochdalek's hernia (BH) is a very rare form of diaphragmatic hernias. Partly due to the exotic nature of this hernia in adult patients, there is no consensus on diagnostic algorithms and clearly established indications for surgical management. Objective. To assess the prospect and feasibility of an individual approach to the diagnosis and choice of surgical treatment on a clinical case of BH. Material and methods. A rare case of BH in a female patient initially hospitalized with a suspected hepatopancreatobiliary pathology. MSCT of the abdomen has been done that allowed to establish the diagnosis of BH. Laparoscopic surgery with simultaneous cholecystectomy and abdominal wall incisional hernia repair minimizes postoperative morbidity and reduces hospital length of stay up to 7 days. Results. Because BH is uncommon there still remains a tendency to follow up patients with this pathology. In adults BH does not have a specific clinical presentation, so MSCT is definitely advisable for the purpose of differential diagnosis. It is necessary to be aware of the precipitating factors, that increase intra-abdominal pressure, the most common and dangerous of which are obesity and, in some cases, pregnancy. Misdiagnosis of BH still reaches up to 35 – 49%, thus resulting in increased number of complications and fatal outcomes. Conclusion. Timely diagnosis of BH allows to perform a planned surgical procedure. The best surgical approaches are laparoscopic or thoracoscopic repair with the possible use of synthetic or biological mesh grafts.