Massive right-sided Bochdalek hernia with two unusual findings: a case report.
BACKGROUND
In this report, the case of an adult patient with a massive right-sided Bochdalek hernia with multiple displaced abdominal organs, including the liver and gallbladder, is described. This patient presented with acute cholecystitis of the malpositioned gallbladder. During surgery, nodular regenerative hyperplasia of the liver was also found. To the best of this author's knowledge, these two entities have never been reported in association with this rare condition.


METHODS
A 54-year-old Caucasian man presented with nausea and epigastric pain. He had a known history of right-sided Bochdalek hernia which was being managed expectantly. A computerized tomogram revealed the massive hernia with displaced stomach, liver, intestine and omentum into his right thorax. It was believed that our patient had bowel incarceration and he was therefore taken to surgery, where acute cholecystitis and a macronodular liver was identified. A thoracoabdominal approach was used to remove his gallbladder, reduce the herniated viscera and reconstruct his diaphragm. A liver biopsy identified nodular regenerative hyperplasia of the ectopic liver. There were no postoperative complications and at 12 month follow-up, our patient continues to do well.


CONCLUSIONS
This case report describes two unusual findings associated with a congenital Bochdalek diaphragmatic hernia that have never been reported. In addition, unique caveats to the surgical management of this complex rare condition are discussed.
Thoracic Surgical Services, Western Maryland Regional Medical Center, 12502 Willowbrook Road, Suite 470, Cumberland, Maryland 21502, USA. sdeb@wmhs.com.
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