Late-presenting congenital diaphragmatic hernia with tension gastrothorax: a case series

• Main Authors: Mohamed Nahrudin, Khairoon Diyana, Ab. Rahman, Norhafiza, Othman, Mohd Yusran, Abdullah, Mohd Yusof
• Format: Conference or Workshop Item
• Language: English; English
• Published: 2022
• Subjects: R Medicine (General); RD Surgery; RJ Pediatrics
• Online Access: http://irep.iium.edu.my/98233/1/CASESERIESPOSTERAGM2022edited24thMay%20%282%29.pdf; http://irep.iium.edu.my/98233/13/98233_Late-presenting%20congenital%20diaphragmatic%20hernia%20with%20tension.pdf; http://irep.iium.edu.my/98233/
• Institution: Universiti Islam Antarabangsa Malaysia

Introduction: Congenital diaphragmatic hernia (CDH) is commonly diagnosed during neonatal period, however they may be detected at a later age with various clinical manifestation. We share 3 cases of tension gastrothorax as a manifestation of late-onset CDH. Case summary: Case 1: A 10-month-old boy presented with worsening respiratory distress requiring intubation. Chest radiograph revealed a huge lucency in the left hemithorax with mediastinal shift which improved after nasogastric tube insertion. CT thorax confirmed the diagnosis of left CDH. Laparotomy revealed 5x6 cm posterolateral defect was seen, content completely reduced and the defect was primarily repaired. Case 2: A 22-month-old baby boy presented with rapid breathing with reduced air entry on the left side. Chest radiograph revealed a lucent left hemithorax causing mediastinal shift. Patient was misdiagnosed as tension pneumothorax and tube thoracostomy was performed in emergency department. CT thorax confirmed presence of CDH and surgical referral was made for primary repair. No stomach injury due to chest tube insertion was seen. Case 3: A 12-month-old boy presented with abdominal pain and intractable crying. Chest X-ray suggestive of CDH. Ultrasound assessment showed a suspicion of left CDH with gastric volvulus. Hence, emergency laparotomy was performed . Content was reduced completely and healthy. Primary repair was performed. Conclusion: Late-onset CDH with a tension gastrothorax must be recognised and managed promptly to relief the mediastinal shift. Misdiagnosis of a tension pneumothorax poses a risk of stomach perforation following tube thoracotomy. Suspicion of gastric volvulus otherwise requires an urgent exploration.