Thoracic kidney nephrectomy due to recurrent Bochdalek hernia in an adult Nefrectomía de riñón intratorácico derecho debido a recurrencia de hernia de Bochdaleck en un paciente adulto

Mónica Sanz del Pozo ^a, Ángel García de Jalón Martínez ^a, Pablo Andrés Ordóñez Lozano ^b, José Manuel Sánchez Zalabardo ^aa
Department of Urology, Quironsalud Zaragoza Hospital, Mariano Renovales, 50006, Spain^b
Department of Thoracic Surgery, Quironsalud Zaragoza Hospital, Mariano Renovales, 50006, Spain
Received 28 March 2022, Accepted 11 June 2022, Available online 2 March 2023, Version of Record 2 March 2023.

Abstract

Congenital diaphragmatic hernia incidence is one in 3000 live births, Bochdalek hernia occurs through a posterolateral defect. It is very rare in adults. We present a case of late relapsed one diagnosed in an adult male. He underwent an open intervention of Bochdalek hernia at first day of life and required reintervention at seventh month due to recurrence. Now, computerized tomography scan demonstrates a right diaphragmatic defect with intrathoracic hydronephrotic kidney. Nephrectomy was performed with Video-assisted Thoracic Surgery using laparoscopic ports and material. The diaphragmatic defect was closed with a polypropylene mesh. The patient was discharged after 72 h.

Resumen

La incidencia de hernia diafragmática congénita es de uno en 3000 nacidos vivos, la hernia de Bochdalek ocurre a través de un defecto diafragmático posterolateral. Es muy raro en adultos. Presentamos un caso de recidiva tardía diagnosticada en un varón adulto. Se sometió a una intervención abierta de hernia de Bochdalek el primer día de vida y requirió reintervención por recurrencia al séptimo mes. La tomografía computarizada actual demuestra un defecto diafragmático derecho con riñón hidronefrótico intratorácico. Se realizó nefrectomía mediante cirugía torácica vídeo-asistida utilizando puertos y material laparoscópicos. El defecto diafragmático se cerró con una malla de polipropileno. El paciente fue dado de alta a las 72 horas de la intervención.

Introduction

The incidence of congenital diaphragmatic hernia (CDH) is one in 3000 live births. It is very rare in adults.¹ Depending on the location of the herniation, they have different names: Bochdalek hernia (BH) occurs through a posterolateral diaphragmatic defect whereas Morgagni hernia appears through an anterior retrosternal or parasternal diaphragmatic defect. BH was first described by Vincenz Alexaner Bochdalek in 1848² and constitutes 80%–90% of all CDH. It follows from incomplete fusion of pleuroperitoneal folds during early fetal development.³ It is diagnosed shortly after birth in most of the cases. It remains asymptomatic in many adults and is incidentally diagnosed in 5% of cases on routine investigations for abdominal or respiratory problems. BH can include the omentum (92%), splenic flexure of the colon (58%), stomach (25%), and spleen on the left side, and liver and small intestine on the right side,² but the presence of kidney is rare. The size of the defect can range from less than one cm to complete absence of the hemidiaphragm.

We present a case of incidentally diagnosed relapsed BH with intrathoracic right kidney in an adult male as part of diagnostic work-up for recurrent respiratory and urinary infections.

Surgical technique

Twenty-one-year-old men presented to Emergency Department with fever and cough. Physical examination revealed decreased respiratory sounds at right hemithorax. He has clinical history of repeated respiratory infections since his childhood, and urinary tract infections for the past four years.

He underwent a subcostal laparotomy at first day of life due to sudden distress, with a chest radiograph that showed diaphragm elevation and mediastinal deviation to left side. Herniated contents were right

Discussion

CDH is a rare condition with an incidence of 0.08−0.45 per 1000 births.¹ BH it is the most common one. This alteration is produced by an absence of closure of the pleuroperitoneal duct between weeks eight and ten of intrauterine life.³ Most BH present as neonatal respiratory distress or gastrointestinal obstruction and are immediately repaired, which has a morbidity rate up to 50%, so it rarely progresses to adulthood.⁴ Nevertheless, in adults, asymptomatic patients typically are female with

Funding and conflict of interest

Authors declare that they have no conflicts of interest nor financial support to disclose. All authors have approved the final version of the manuscript, which is not under consideration for publication elsewhere.

References

P. Minneci et al.Foramen of Morgagni hernia: changes in diagnosis and treatmentAnn Thorac Surg(2004)
H. Skari et al.Congenital diaphragmatic hernia: a meta-analysis of mortality of factorsJ Pediatr Surg(2000)
M. Langham et al.Congenital diaphragmatic hernia: epidemiology and outcomeClin Perinatol(1996)
N. Kumar et al.Bochdalek hernia in adult female with intrathoracic left kidney and splenic flexure of colon: a rare case report with literature reviewPolish J Surg(2019)

There are more references available in the full text version of this article.

Thoracic kidney nephrectomy due to recurrent Bochdalek hernia in an adult Nefrectomía de riñón intratorácico derecho debido a recurrencia de hernia de Bochdaleck en un paciente adulto

Abstract

Resumen

Introduction

Surgical technique

Discussion

Funding and conflict of interest

References

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