Massive right-sided Bochdalek hernia with two unusual findings: a case report

Area of Science:

• Surgical Case Reports
• Gastroenterology
• Diaphragmatic Hernia Research

Background:

• A massive right-sided Bochdalek hernia (congenital diaphragmatic hernia) is described in an adult patient.
• The hernia involved significant displacement of abdominal organs, including the liver and gallbladder, into the thoracic cavity.
• The patient presented with acute cholecystitis of the malpositioned gallbladder.

Purpose of the Study:

• To report a rare case of adult Bochdalek hernia with unusual associated findings.
• To highlight the co-occurrence of acute cholecystitis and nodular regenerative hyperplasia of the liver in this context.
• To discuss surgical management considerations for complex Bochdalek hernias.

Main Methods:

• A 54-year-old male with a known right-sided Bochdalek hernia presented with acute symptoms.
• Diagnostic imaging confirmed massive herniation of abdominal contents into the thorax.
• Surgical intervention involved a thoracoabdominal approach for cholecystectomy, hernia reduction, and diaphragmatic repair.

Main Results:

• Acute cholecystitis of the malpositioned gallbladder was identified during surgery.
• Nodular regenerative hyperplasia (NRH) of the ectopic liver was diagnosed via biopsy.
• The patient experienced an uncomplicated recovery and remains well at 12-month follow-up.

Conclusions:

• This report documents the first known association of acute cholecystitis and NRH with a massive adult Bochdalek hernia.
• The case underscores the potential for rare complications and emphasizes unique surgical approaches for such conditions.
• Further research into the pathophysiology and management of complex Bochdalek hernias is warranted.