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Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature.
J Pediatr Surg. 2008 03; 43(3):E35-9.JP

Abstract

Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. Nasogastric decompression was unsuccessful. Via a thoracoscopic approach, the large fluid-filled stomach was percutaneously decompressed but could not be reduced. Through a left subcostal incision, a left-sided diaphragmatic defect about 4 x 5 cm was encountered. A large portion of small intestines, ascending and transverse colon, strangulated but viable stomach, and a large spleen herniated through the defect. The contents were reduced, revealing a combined gastric volvulus. Once the diaphragmatic defect was repaired primarily, there was insufficient space in the abdominal cavity to contain all the viscera reduced form the chest. Therefore, we placed an AlloDerm patch on the fascia and closed with a wound V.A.C (Kinetic Concepts Inc, San Antonio, TX). Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Anaya-Ayala JE
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030-2399, USA.
Naik-Mathuria B
No affiliation info available
Olutoye OO
No affiliation info available

MeSH

Abdominal PainChildDiagnosis, DifferentialDyspneaFemaleFollow-Up StudiesHernia, DiaphragmaticHernias, Diaphragmatic, CongenitalHumansMagnetic Resonance ImagingMinimally Invasive Surgical ProceduresRadiography, ThoracicRisk AssessmentSeverity of Illness IndexStomach VolvulusThoracoscopyTime FactorsTomography, X-Ray ComputedTreatment Outcome

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

18358272

Citation

Anaya-Ayala, Javier E., et al. "Delayed Presentation of Congenital Diaphragmatic Hernia Manifesting as Combined-type Acute Gastric Volvulus: a Case Report and Review of the Literature." Journal of Pediatric Surgery, vol. 43, no. 3, 2008, pp. E35-9.
Anaya-Ayala JE, Naik-Mathuria B, Olutoye OO. Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. J Pediatr Surg. 2008;43(3):E35-9.
Anaya-Ayala, J. E., Naik-Mathuria, B., & Olutoye, O. O. (2008). Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. Journal of Pediatric Surgery, 43(3), E35-9. https://doi.org/10.1016/j.jpedsurg.2007.11.015
Anaya-Ayala JE, Naik-Mathuria B, Olutoye OO. Delayed Presentation of Congenital Diaphragmatic Hernia Manifesting as Combined-type Acute Gastric Volvulus: a Case Report and Review of the Literature. J Pediatr Surg. 2008;43(3):E35-9. PubMed PMID: 18358272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. AU - Anaya-Ayala,Javier E, AU - Naik-Mathuria,Bindi, AU - Olutoye,Oluyinka O, PY - 2007/08/02/received PY - 2007/11/09/revised PY - 2007/11/09/accepted PY - 2008/3/25/pubmed PY - 2008/5/13/medline PY - 2008/3/25/entrez SP - E35 EP - 9 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 43 IS - 3 N2 - Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. Nasogastric decompression was unsuccessful. Via a thoracoscopic approach, the large fluid-filled stomach was percutaneously decompressed but could not be reduced. Through a left subcostal incision, a left-sided diaphragmatic defect about 4 x 5 cm was encountered. A large portion of small intestines, ascending and transverse colon, strangulated but viable stomach, and a large spleen herniated through the defect. The contents were reduced, revealing a combined gastric volvulus. Once the diaphragmatic defect was repaired primarily, there was insufficient space in the abdominal cavity to contain all the viscera reduced form the chest. Therefore, we placed an AlloDerm patch on the fascia and closed with a wound V.A.C (Kinetic Concepts Inc, San Antonio, TX). Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/18358272/Delayed_presentation_of_congenital_diaphragmatic_hernia_manifesting_as_combined_type_acute_gastric_volvulus:_a_case_report_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -