Intricacy of Treatment in a Case of Adult Right-sided Bochdalek Hernia

Abstract

The case was a 66-year-old woman who visited our hospital complaining of both epigastric and right hypochondriac pain from the day before. Her skin had yellowed, and she was in septic state with severe inflammatory response, impaired consciousness, and a decreased blood pressure. Computed tomography revealed a highly swollen gallbladder, with part of the liver and hepatic flexion of the colon in the right thoracic cavity. Passive atelectasis in the lower lobe of the right lung, pleural effusion, common bile duct stones, dilation of the intrahepatic bile duct, and the enlargement and leftward displacement of the left hepatic lobe were also observed. Our diagnosis was acute cholecystitis and cholangitis in a right-sided Bochdalek hernia. We excluded emergency surgery since the hernia portion of the liver and blood supply to the colon were not impaired, and the colon was not obstructed. Nevertheless, percutaneous transhepatic cholangial drainage was performed on the same day via the left hepatic lobe to cure cholangitis. The inflammation of the gallbladder and the bile duct quickly disappeared, and ingestion was possible again. After endoscopic lithotomy of the common bile duct stones, Bochdalek hernia repair and cholecystectomy were performed simultaneously on the 58th day after treatment. The postoperative course was good, and the patient was discharged on the 11th day after surgery.