Undiagnosed maternal diaphragmatic hernia – a management dilemma

Reddy, Maya; Kroushev, Annie; Palmer, Kirsten

doi:10.1186/s12884-018-1864-4

Cited by 15 publications

(10 citation statements)

References 44 publications

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“…7 The increase of intra-abdominal pressure during pregnancy by the uterus is perhaps the factor that contributes to the presentation of more severe cases, with management implicating greater risks. 7…”

Section: Discussionmentioning

confidence: 99%

Maternal Diaphragmatic Hernia Correction During Pregnancy

et al. 2021

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Congenital diaphragmatic hernia consists of a defect in the embryonic development of the diaphragm that allows the passage of the abdominal viscera into the thoracic cavity, its diagnosis during pregnancy is quite rare. We present the case of a 31-year-old woman, with 23 weeks of gestation, who consulted for epigastric pain, nausea, and repetitive emetic episodes, without improvement with the medication provided. Due to the intense abdominal pain, a computed tomography of the abdomen and thorax was performed where the 28 mm defect was found at the left diaphragmatic level with protrusion of the gastric fundus to the thoracic cavity. She was taken to surgical management by laparoscopy with abdominal and thoracic approach, with a successful result and without maternal perinatal complications. Although the integrity of the diaphragmatic suture could be feared in relation to the increase in intraabdominal pressure due to uterine growth, the evolution of our patient and previous reports show that postoperative complications are not frequent. Successful vaginal delivery has even been described in some reports. Diaphragmatic hernias diagnosed during pregnancy are quite rare. We suggest that the optimal management of them during pregnancy is immediate surgical correction in case of persistent symptoms, more studies are needed to establish firm recommendations on the management of this pathology.

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Section: Discussionmentioning

confidence: 99%

Maternal Diaphragmatic Hernia Correction During Pregnancy

et al. 2021

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“…In addition to hormonal and metabolic changes, the uterus will also expand several times in the third trimester of pregnancy, which can increase the pressure in the abdomen. As part of the diaphragm between the abdominal cavity and thoracic cavity disappears, there is more space for the abdominal viscera to move[ 8 ]. The gradually enlarging gravid uterus and higher abdominal pressure squeeze the body organs, such as the liver, stomach, and small intestine, into the thoracic cavity.…”

Section: Discussionmentioning

confidence: 99%

Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report

Zou

Yang

Zhou

et al. 2020

WJCC

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BACKGROUND The occurrence of a diaphragmatic hernia during the third trimester of pregnancy is rare; to our knowledge, there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy. Nonspecific symptoms and lack of experience due to its rarity make the diagnosis of this condition very challenging. We report a case of diaphragmatic hernia accompanied by mild acute pancreatitis in the third trimester of pregnancy, which was misdiagnosed as severe acute pancreatitis. CASE SUMMARY A 19-year-old woman presented at gestation of 31 +2 weeks with continuous distension pain for 3 d in the left lumbar region of no obvious cause. Ultrasonographic findings of left ureterectasis, with nonspecific lumbago and abdominal pain, led to the misdiagnosis of renal colic. Increased serum amylase and/or lipase levels indicated acute pancreatitis. Following the treatment of pancreatitis, her condition deteriorated. The patient was finally diagnosed with a diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital. Caesarean section was performed at gestation of 31 +6 weeks, followed by hernia repair, and the pancreatitis was treated sequentially. The patient was discharged in good condition 20 d after the surgery. CONCLUSION In this case, surgical treatment was not the same as that for non-pregnant diaphragmatic hernia repair. It is important to first perform a cesarean section before commencing the therapy.

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“…en la literatura se han descrito 56 casos de hernias diafragmáticas maternas durante el embarazo, se reporta que 54% se presentaron después de las 24 semanas de gestación, 21% antes de las 24 semanas, 20% durante el trabajo de parto o el postparto y 5% no informó gestación. 5 En este caso, coincidente con lo descrito en la literatura, fue identificada como complicación en el segundo trimestre del embarazo 4 debido al incremento de la presión intraabdominal secundario al crecimiento uterino y al aumento en la secreción de progesterona que se asocia a la relajación diafragmática. 6 La evolución clínica de la patología fue coincidente con lo reportado ante la presencia de dolor torácico y epigástrico, acompañada de náusea, vómitos, taquicardia y disnea debido al aumento del trabajo ventilatorio asociado a colapso pulmonar izquierdo por contenido intraabdominal documentado por TC torácica al ser la técnica que se asocia con una sensibilidad de 78% en este tipo de hernias.…”

Section: Discussionunclassified

“…8 Al no existir consenso descrito en la literatura respecto al manejo terapéutico, se decidió el mismo con base en la presentación y la edad gestacional menor de 24 semanas, 9 bajo laparotomía con cierre primario, resección de colon y derivación intestinal ante la emergencia del caso debido a la clínica de la paciente, el tamaño del defecto, la presencia de posibles incidencias y tratamiento conservador obstétrico para lograr madurez fetal hasta la semana 30 de gestación. 5,10 El reto potencial del manejo de complicaciones como la sepsis, el neumotórax, los trastornos hidroelectrolíticos, intercambio de gases y el adecuado aporte nutricional fueron abordados de manera multidisciplinaria apegados a las recomendaciones reportadas en la literatura internacional.…”

Section: Wwwmedigraphicorgmxunclassified