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Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress.
Pediatr Emerg Care. 2012 Oct; 28(10):1078-80.PE

Abstract

INTRODUCTION

Congenital diaphragmatic hernia is an embryologic defect that creates a passage for herniation of abdominal structures into the thoracic cavity. This can lead to a variety of complications, including gastric volvulus that can present acutely with epigastric distention and vomiting. In cases of late-onset congenital diaphragmatic hernia, symptoms may be vague and often necessitate further investigation.

CASE

Our patient is a 12-month-old previously healthy female infant who presented to the emergency department with a history of vomiting and acute onset respiratory distress. Her SaO(2) was 94% to 98% on room air, her respiratory rate was in the 80s breaths per minute, and she was noted to have severe retractions. Her chest examination revealed absent breath sounds on the left side. Her abdominal examination was unremarkable. The acute presentation of respiratory distress was initially concerning for a foreign body aspiration, but a chest radiograph demonstrated left-sided opacification and mediastinal shift to the right. The patient required intubation for respiratory decompensation and a subsequent computed tomographic scan showed diaphragmatic hernia with gastric volvulus.

CONCLUSIONS

This patient's presentation highlights one of the complications that may occur owing to congenital diaphragmatic hernia. Computed tomographic scan is the confirmatory test for diaphragmatic hernia and, in this case, also uncovered a concomitant gastric volvulus. Treatment includes early resuscitation, a definitive airway, and emergent surgery to prevent ischemic necrosis of the stomach owing to strangulation, gastric perforation, and serious cardiorespiratory decompensation.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ito TE
School of Medicine, Southern Illinois University, Springfield, IL, USA.
Hasnie R
No affiliation info available
Crosby DL
No affiliation info available
Milbrandt JC
No affiliation info available
Ettema S
No affiliation info available
Duong M
No affiliation info available

MeSH

Acute DiseaseDiagnosis, DifferentialDiagnostic ErrorsDyspneaFemaleHernia, DiaphragmaticHernias, Diaphragmatic, CongenitalHumansInfantRadiography, ThoracicStomach VolvulusTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

23034498

Citation

Ito, Traci E., et al. "Gastric Volvulus Complication in an Infant With Undiagnosed Congenital Diaphragmatic Hernia Presenting With Acute Respiratory Distress." Pediatric Emergency Care, vol. 28, no. 10, 2012, pp. 1078-80.
Ito TE, Hasnie R, Crosby DL, et al. Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress. Pediatr Emerg Care. 2012;28(10):1078-80.
Ito, T. E., Hasnie, R., Crosby, D. L., Milbrandt, J. C., Ettema, S., & Duong, M. (2012). Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress. Pediatric Emergency Care, 28(10), 1078-80. https://doi.org/10.1097/PEC.0b013e31826cedaf
Ito TE, et al. Gastric Volvulus Complication in an Infant With Undiagnosed Congenital Diaphragmatic Hernia Presenting With Acute Respiratory Distress. Pediatr Emerg Care. 2012;28(10):1078-80. PubMed PMID: 23034498.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress. AU - Ito,Traci E, AU - Hasnie,Rubab, AU - Crosby,Dana L, AU - Milbrandt,Joseph C, AU - Ettema,Sandra, AU - Duong,Myto, PY - 2012/10/5/entrez PY - 2012/10/5/pubmed PY - 2013/3/27/medline SP - 1078 EP - 80 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 28 IS - 10 N2 - INTRODUCTION: Congenital diaphragmatic hernia is an embryologic defect that creates a passage for herniation of abdominal structures into the thoracic cavity. This can lead to a variety of complications, including gastric volvulus that can present acutely with epigastric distention and vomiting. In cases of late-onset congenital diaphragmatic hernia, symptoms may be vague and often necessitate further investigation. CASE: Our patient is a 12-month-old previously healthy female infant who presented to the emergency department with a history of vomiting and acute onset respiratory distress. Her SaO(2) was 94% to 98% on room air, her respiratory rate was in the 80s breaths per minute, and she was noted to have severe retractions. Her chest examination revealed absent breath sounds on the left side. Her abdominal examination was unremarkable. The acute presentation of respiratory distress was initially concerning for a foreign body aspiration, but a chest radiograph demonstrated left-sided opacification and mediastinal shift to the right. The patient required intubation for respiratory decompensation and a subsequent computed tomographic scan showed diaphragmatic hernia with gastric volvulus. CONCLUSIONS: This patient's presentation highlights one of the complications that may occur owing to congenital diaphragmatic hernia. Computed tomographic scan is the confirmatory test for diaphragmatic hernia and, in this case, also uncovered a concomitant gastric volvulus. Treatment includes early resuscitation, a definitive airway, and emergent surgery to prevent ischemic necrosis of the stomach owing to strangulation, gastric perforation, and serious cardiorespiratory decompensation. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/23034498/Gastric_volvulus_complication_in_an_infant_with_undiagnosed_congenital_diaphragmatic_hernia_presenting_with_acute_respiratory_distress_ DB - PRIME DP - Unbound Medicine ER -