Congenital Diaphragmatic Hernia With Intra Thoracic Gastric Volvulus: A Rare, Life-Threatening Combination

Abstract

Congenital diaphragmatic hernia (CDH) is a known cause of secondary gastric volvulus (GV). Both entities are life-threatening, either alone or in exceedingly rare instances when they occur in combination. Here, we describe one such rare combination of CDH and secondary GV in a nine-year-old boy, who presented to us with recurrent episodes of abdominal pain. Urgent laparotomy was done after radiological evaluation (X-ray of chest and abdomen and contrast-enhanced CT chest and abdomen), which revealed mesenterico-axial volvulus of the stomach, secondary to an underlying diaphragmatic defect in the left hemidiaphragm, thus establishing the cause (diaphragmatic defect) and effect (GV), and resulting in a favourable outcome.

Comparison of the incidence of intrathoracic stomach in Bochdalek's hernia detected by imaging with that detected by surgery

“…Secondly, the respiratory movement caused pressure change in the chest, with the abdominal organs being constantly pulled and pushed by the pressure changes. Finally, there had been reports of defects or absence of gastrophrenic and gastrosplenic ligaments in patients with CDH [22] ,and in these patients, the stomach might herniated into the chest. Nevertheless, after the gastric hernia entered the chest cavity, the stomach cannot easily returned to the abdominal cavity due to the small diaphragmatic defect and stomach distension.…”

“…Nevertheless, after the gastric hernia entered the chest cavity, the stomach cannot easily returned to the abdominal cavity due to the small diaphragmatic defect and stomach distension. Some patients may even had acute obstruction or perforation due to gastric torsion [22,23] .…”