Tokumoto et al. Journal of Medical Case Reports 2010, 4:366 http://www.jmedicalcasereports.com/content/4/1/366 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report Noriaki Tokumoto1, Kazuaki Tanabe1*, Hideki Yamamoto1, Takahisa Suzuki1, Yoshihiro Miyata2, Hideki Ohdan1 Abstract Introduction: Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. Once a Bochdalek hernia has been diagnosed, surgical treatment is necessary to avoid complications such as perforation and necrosis. Case presentation: We present a 17-year-old Japanese boy with left-upper-quadrant pain for two months. Chest radiography showed an elevated left hemidiaphragm. Computed tomography revealed a congenital diaphragmatic hernia. The spleen and left colon had been displaced into the left thoracic cavity through a left posterior diaphragmatic defect. We diagnosed a Bochdalek hernia. Surgical treatment was performed via a thoracoscopic approach. The boy was placed in the reverse Trendelenburg position and intrathoracic pressure was increased by CO2 gas insufflations. This is a very useful procedure for reducing herniated contents and we were able to place the herniated organs safely back in the peritoneal cavity. The diaphragmatic defect was too large to close with thoracoscopic surgery alone. Small incision thoracotomy was required and primary closure was performed. His postoperative course was uneventful and there has been no recurrence of the diaphragmatic hernia to date. Conclusion: Thoracoscopic surgery, performed with the boy in the reverse Trendelenburg position and using CO2 gas insufflations in the thoracic cavity, was shown to be useful for Bochdalek hernia repair. Introduction Congenital diaphragmatic hernias (CDHs) occur when muscular portions of the diaphragm fail to develop normally, resulting in the displacement of abdominal components into the thoracic cavity [1]. CDHs occur mainly during the eighth to the tenth weeks of fetal life. They consist of Bochdalek, hiatal and Morgagni hernias. Bochdalek hernias, caused by posterolateral defects of the diaphragm, were first described by Boch- dalek in 1848 [2]. They usually present with severe respiratory distress immediately after birth, which is life-threatening. Once diagnosed, Bochdalek hernias should be surgically treated during the neonatal period. Therefore, adult cases are rare, with a reported frequency of 0.17% to 6% among all diaphragmatic hernias [3,4]. * Correspondence: ktanabe2@hiroshima-u.ac.jp 1Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Full list of author information is available at the end of the article We performed minimally invasive surgery under thoracoscopic guidance, for an incidentally diagnosed Bochdalek hernia in an adult [5,6]. We describe the sur- gical procedures for thoracoscopic-assisted Bochdalek hernia repair and its advantages and disadvantages. Case presentation A 17-year-old Japanese boy was referred to our hospital with a suspected CDH. He had experienced occasional left-upper-quadrant pain for two months. The pain then intensified and occurred more often. He consulted a neighborhood clinic, and was referred to our hospital. There was no history of trauma. Chest radiography showed elevation of the left diaphragm (Figure 1). Computed tomography (CT) of the chest revealed CDH (Figure 2). The spleen and left colon had herniated into the left thoracic space through a left posterior diaphrag- matic defect. We therefore diagnosed the patient as having a Bochdalek hernia. He was prepared for surgery via a left thoracoscopic approach, under one lung ventilation, using a double- © 2010 Tokumoto et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.