A Case of Bochdalek Hernia Complicated by Gastric Volvulus

Abstract

The patient was a 19-year-old male who visited our hospital with complaints of frequent vomiting, hematemesis, and abdominal pain. Contrast-enhanced computed tomography (CT) revealed herniation of the intra-abdominal organs into the thoracic cavity, with gastric volvulus. The volvulus was reduced endoscopically, followed by placement of a nasogastric tube and elective surgery performed three days after admission. Laparoscopic exploration revealed a large 7-cm hernial defect in the dorsal aspect of the left diaphragm, and we made the diagnosis of Bochdalek hernia. The herniated organs were returned to the abdominal cavity, the hernial defect was closed by primary suturing, and gastric fixation was performed. The patient was discharged on the seventh postoperative day. Adult-onset Bochdalek hernias are relatively rare, especially in association with gastric volvulus. When the stomach is dilated, it may be difficult to obtain a good surgical field and reduce the herniated organs. Thus, in cases where elective surgery is possible, a laparoscopic approach after gastric decompression is considered to be less invasive and more useful than open surgery.