Open mesh repair of an iatrogenic post-nephrectomy Bochdalek hernia in an adult: a case study

Abstract

Bochdalek hernias arise from a developmental failure of the pleuroperitoneal canal to close, allowing abdominal contents to herniate into the thorax and compress the developing lung parenchyma. In rare cases, Bochdalek hernias may arise in adults and usually present with symptoms related to the hernia. Treatment consists of either open, laparoscopic, or robotic repair to close the defect. We present an unusual case in which an elderly patient presented with a large left-sided Bochdalek hernia containing both an incarcerated stomach and spleen following an uncomplicated robotic left nephrectomy. The hernia was successfully reduced and reconstructed with mesh via open abdominal repair with minimal complications. Repairing these hernias is challenging and, as in this case, required a complex reconstruction of diaphragm with mesh attachment to the ribs. Further reports on acute management of iatrogenic Bochdalek hernias in adults are warranted to better understand long-term post-operative outcomes and optimize management.