PDF(Pubmed)
Abstract：
Hiatal hernias and Bochdalek hernias are two types of diaphragmatic hernias that present with similar symptoms. However, they differ in their etiology and anatomical location. In this case study, we present the clinical features and management of a patient who presented with symptoms suggestive of a hiatal hernia but was later diagnosed with a Bochdalek hernia. Our case has a 64-year-old female patient who presented with chronic obstructive pulmonary disease, hypertension, and gastroesophageal reflux disease. During her pulmonologist-ordered imaging, which included a CT scan, the report showed a large 8 cm hiatal hernia. Due to her condition, she was scheduled for a hiatal hernia repair, along with a transoral incisionless fundoplication (TIF) procedure. During the operation, a large defect was seen in the left hemidiaphragm with herniation of bowel loops into the chest cavity. It was confirmed to be a Bochdalek hernia. The surgeon proceeded to continue the laparoscopic repair, pulling the bowel back into the abdomen, and using the falciform ligament of the liver to buttress the diaphragm. The surgery was a success, and the patient had no postoperative complications. This case serves as a reminder that a high degree of suspicion is required for the diagnosis of Bochdalek hernias, especially in patients with atypical presentations or imaging findings suggestive of an alternative diagnosis, such as a hiatal hernia. The patient had chronic symptoms of various gastrointestinal and respiratory comorbidities, which should serve as a caution for clinicians to carefully consider the possibility of a Bochdalek hernia when evaluating patients with similar symptoms. This case study also illustrates the success of a minimally invasive surgical approach for repairing a Bochdalek hernia, with the use of laparoscopic techniques and using falciform ligament to support the diaphragm.
摘要：
裂孔疝和Bochdalek疝是两种类型的膈疝，症状相似。然而,它们的病因和解剖位置不同。在这个案例研究中,我们介绍了1例表现为食管裂孔疝症状,但后来被诊断为Bochdalek疝的患者的临床特征和治疗方法.我们的病例中有一名64岁的女性患者，她患有慢性阻塞性肺疾病，高血压,和胃食管反流病.在她的肺科医师下令成像期间，包括CT扫描，报告显示有一个8厘米大的食管裂孔疝。由于她的病情,她被安排做食管裂孔疝修补,经口无切口胃底折叠术(TIF)。在操作过程中,在左半膈中发现了一个大的缺损，肠loop突出到胸腔中。证实是Bochdalek疝气。外科医生继续进行腹腔镜修复，把肠子拉回腹部,利用肝脏的镰状韧带支撑隔膜。手术很成功,患者无术后并发症。这个病例提醒人们,对Bochdalek疝气的诊断需要高度怀疑,特别是在非典型表现或影像学表现提示替代诊断的患者中，比如食管裂孔疝.患者有各种胃肠道和呼吸道合并症的慢性症状，临床医生在评估具有类似症状的患者时，应谨慎考虑Bochdalek疝气的可能性。该案例研究还说明了微创手术方法修复Bochdalek疝气的成功，使用腹腔镜技术和使用镰状韧带支撑隔膜。
