Atalay ŞAHİN, Fatih METEROĞLU, Serdar ONAT, Menduh ORUÇ

Yetişkin Bochdalek hernisi: Sekiz hastanın analizi

Amaç: Bu çalışmada yetişkin yaş gruplarında doğuştandiyafragma hernili olgular irdelendi.Çalışma planı: Ocak 2005 - Haziran 2013 tarihleriarasında kliniğimizde ameliyat edilen ileri yaş Bochdalekhernisi olan sekiz hastanın (3 erkek, 5 kadın; ort. yaş31.4 yıl; dağılım 18-53 yıl) dosyaları geriye dönük olarakincelendi. Hastaların yaşı, cinsiyeti, eşlik eden hastalıkları,semptomları, cerrahi yaklaşım yeri, toraksta bulunanbatın organları, ameliyat sonrası morbidite ve mortaliteoranları ve hastanede kalış süreleri değerlendirildi.Bulgular: Öksürük, göğüs ağrısı ve nefes darlığı enyaygın semptomlar idi. Oskültasyonda altı hastadatoraksta bağırsak sesleri vardı. Solunum fonksiyontestleri, iki düzlemli akciğer grafisi ve toraksbilgisayarlı tomografi uygulandı. Bochdalek hernisiyedi hastada sol, bir hastada sağ tarafta yerleşimli idi.Bir hastaya posterolateral torakotomi + laparotomi,diğer yedi hastaya ise posterolateral torakotomiuygulandı. Ameliyat sonrası morbidite ve mortalitegözlenmedi. Ortalama hastanede kalış süresi 8.75 gün(dağılım 4-25 gün) idi. Hastalar ortalama 28.13 ay(3-60 ay) takip edildi.Sonuç: Doğuştan diyafragma hernisi nadir de olsaileri yaş gruplarında görülebilir. Semptomatik olmayanhastalarda zamanla yaşamı tehdit eden komplikasyonlargelişebilir. Tanı konulduktan sonra cerrahi tedavigereklidir.

Adult Bochdalek hernia: an analysis of eight patients

Background: This study aims to analyze congenitaldiaphragmatic hernias in adult age groups.Methods: We retrospectively studied files of eight patients(3 males, 5 females; mean age 31.4 years; range 18 to 53years) of Bochdalek hernias of advanced age who wereoperated in our clinic between January 2005 and June 2013.Patients' age, sex, associated diseases, symptoms, surgicalaccess, abdominal organs in the thorax, postoperativemorbidity and mortality rates, and duration of hospital staywere evaluated.Results: Cough, chest pain, and dyspnea were the mostcommon symptoms. Intestinal sounds in the thoraxwere present in six patients on auscultation. Pulmonaryfunction tests, biplane chest X-rays, and thoracic computedtomography were performed. Bochdalek hernia was locatedon the left side in seven patients and on the right side inone patient. Posterolateral thoracotomy + laparotomy wereperformed in one patient, while posterolateral thoracotomywas performed in the other seven patients. No postoperativemorbidity or mortality was observed. The mean duration ofhospital stay was 8.75 days (range 4-25 days). Patients werefollowed up for a mean of 28.13 months (range 3-60 months).Conclusion: Although rarely, congenital diaphragmatichernias may be seen in the older age groups. Lifethreateningcomplications may develop in asymptomaticpatients over time. Surgical treatment is essential upondiagnosis.

PDF

___

1. Reynolds M. Congenital posterolateral diaphragmatic hernias and other less common hernias of the diaphragm in infants and children. In: Shields TW, LoCicero J III, Ponn RB, Rusch VW, editors. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 761-71.
2. Karamustafaoglu YA, Yoruk Y, Kuzucuoglu M, Yanik F. Massive Bochdalek diaphragmatic hernia in adult with hypoplastic lung. Asian Cardiovasc Thorac Ann 2015;23:461-3.
3. Deprest JA, Gratacos E, Nicolaides K, Done E, Van Mieghem T, Gucciardo L, et al. Changing perspectives on the perinatal Europe. Clin Perinatol 2009;36:329-47.
4. Kinoshita F, Ishiyama M, Honda S, Matsuzako M, Oikado K, Kinoshita T, et al. Late-presenting posterior transdiaphragmatic (Bochdalek) hernia in adults: prevalence and MDCT characteristics. J Thorac Imaging 2009;24:17-22.
5. Sener RN, Tugran C, Yorulmaz I, Dagdeviren A, Orguc S. Bilateral large Bochdalek hernias in an adult. CT demonstration. Clin Imaging 1995;19:40-2.
6. Gale ME. Bochdalek hernia: prevalence and CT characteristics. Radiology 1985;156:449-52.
7. Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of incidental Bochdalek's hernia in a large adult population. AJR Am J Roentgenol 2001;177:363-6.
8. Temizöz O, Gençhellaç H, Yekeler E, Umit H, Unlü E, Ozdemir H, et al. Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population. Diagn Interv Radiol 2010;16:52-5.
9. Brown SR, Horton JD, Trivette E, Hofmann LJ, Johnson JM. Bochdalek hernia in the adult: demographics, presentation, and surgical management. Hernia 2011;15:23-30 . 10. Mei-Zahav M, Solomon M, Trachsel D, Langer JC. Bochdalek diaphragmatic hernia: not only a neonatal disease. Arch Dis Child 2003;88:532-5.
11. Newman BM, Afshani E, Karp MP, Jewett TC Jr, Cooney DR. Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 1986;121:813-6.
12. Salaçin S, Alper B, Cekin N, Gülmen MK. Bochdalek hernia in adulthood: a review and an autopsy case report. J Forensic Sci 1994;39:1112-6.
13. Sathyanarayana N, Rao RM, Rai SB. An adult recurrent diaphragmatic hernia with a near complete defect: a rare scenario. J Clin Diagn Res 2012;6:1574-6.
14. Hamid KS, Rai SS, Rodriguez JA. Symptomatic Bochdalek hernia in an adult. JSLS 2010;14:279-81.
15. Laaksonen E, Silvasti S, Hakala T. Right-sided Bochdalek hernia in an adult: a case report. J Med Case Rep 2009;3:9291. 16. Heaton ND, Adam G, Howard ER. The late presentation of postero-lateral congenital diaphragmatic hernias. Postgrad Med J 1992;68:445-8.
17. Fine R, Borrero E, Stone A. Bochdalek hernia in adulthood. N Y State J Med 1987;87:516-8.
18. Wenzel-Smith G. Posterolateral diaphragmatic hernia with small-bowel incarceration in an adult. S Afr J Surg 2013;51:73-4.
19. Choi YK, Ahn JH, Kim KC, Won TH. An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia. Korean J Thorac Cardiovasc Surg 2012;45:348-50.
20. Zenda T, Kaizaki C, Mori Y, Miyamoto S, Horichi Y, Nakashima A. Adult right-sided Bochdalek hernia facilitated by coexistent hepatic hypoplasia. Abdom Imaging 2000;25:394-6.
21. Quah BS, Hashim I, Simpson H. Bochdalek diaphragmatic hernia presenting with acute gastric dilatation. J Pediatr Surg 1999;34:512-4.
22. Prieto Nieto I, Perez Robledo JP, Hardisson D, Granado de la Fuente A. Bochdalek hernia in an adult. Scand Cardiovasc J 1998;32:113-4.
23. La Ganga V, Rossi G, Montobbio A, Gaione M. Bochdalek's diaphragmatic hernia in adults. Description of a clinical case. Minerva Chir 1999;54:443-5. [Abstract]
24. John PH, Thanakumar J, Krishnan A. Reduced port laparoscopic repair of Bochdalek hernia in an adult: A first report. J Minim Access Surg 2012;8:158-60.
25. Yamaguchi M, Kuwano H, Hashizume M, Sugio K, Sugimachi K, Hyoudou Y. Thoracoscopic treatment of Bochdalek hernia in the adult: report of a case. Ann Thorac Cardiovasc Surg 2002;8:106-8.
26. Rajput MZ, Fisichella PM. An 81-year-old gentleman with symptomatic Bochdalek hernia. World J Gastrointest Surg 2013;5:222-3.