Repair of Bochdalek hernia in an adult complicated by abdominal compartment syndrome, gastropleural fistula and pleural empyema: Report of a case.
BACKGROUND
Bochdalek's diaphragmatic hernia (BDH) rarely developed symptomatic in adulthood but mostly required an operation. In adult BDH cases, long-term residing of the massive intraabdominal organs in the thoracic cavity passively causes loss of domain for abdominal organs (LOD).


METHODS
A 63-year-old man presented at our institution complaining of sudden left upper quadrant abdominal pain. Chest radiography showed a hyperdense lesion containing bowel gas in the left pleural space. Computed tomography revealed a dilated bowel above the diaphragm and intestinal obstruction suggestive of gangrenous changes. These findings were consistent with the diagnosis of incarcerated BDH and an emergency laparotomy was performed. Operative findings revealed the hypoplastic lung, lack of hernia sac, and location of the diaphragmatic defect, which indicated that his hernia was true congenital. Organs were reduced into the abdominal cavity, and large defect of the diaphragm was repaired with combination of direct vascular closure and intraperitoneal onlay mesh reinforcement using with expanded polytetrafluoroethylene (ePTFE) mesh. On the postoperative day 1, the patient fell into the shock and was diagnosed to have abdominal compartment syndrome (ACS). Conservative therapies were administered, but resulted in gastropleural fistula and pleural empyema, which required an emergency surgery. Mesh extraction and fistulectomy were performed.


CONCLUSIONS
A PubMed search for the case of ACS after repair of the adult BDH revealed only three cases, making this very rare condition.


CONCLUSIONS
In dealing with adult BDH, possible post-repair ACS should be considered.
Department of Surgery, The Jikei Universiy, Daisan Hospital, Japan. Electronic address: toshiaki1129jp@yahoo.co.jp.
Toshiaki
T
Suzuki
Department of Surgery, The Jikei Universiy, Daisan Hospital, Japan.
Tomoyoshi
T
Okamoto
Department of Surgery, The Jikei Universiy, Daisan Hospital, Japan.
Ken
K
Hanyu
Department of Surgery, The Jikei Universiy, Daisan Hospital, Japan.
Katsuhito
K
Suwa
Department of Surgery, Division of Pediatric Surgery, The Jikei University School of Medicine, Japan.
Shuichi
S
Ashizuka
Department of Surgery, Division of Gastrointestinal Surgery, The Jikei University School of Medicine, Japan.
Katsuhiko
K
Yanaga
Abdominal compartment syndrome; Bochdalek hernia; Gastropleural fistula; Pleural empyema