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Bilateral eventration of the diaphragm with perforated gastric volvulus in an adolescent
1Flushing Hospital Medical Center, Flushing, NY, USA.
Insights
Bilateral congenital diaphragmatic eventration can present later in life with gastric volvulus. This case highlights the need for prompt diagnosis and surgical repair in older children and adults with gastrointestinal symptoms and diaphragmatic abnormalities.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Bilateral congenital diaphragmatic eventration typically presents in infancy causing respiratory distress.
- Delayed presentation in older children and adults can be complicated by acute gastric volvulus.
- Gastric volvulus is a surgical emergency requiring prompt intervention to prevent gastric necrosis and perforation.
Observation:
- A 13-year-old boy with bilateral congenital diaphragmatic eventration presented with symptoms suggestive of gastric volvulus.
- Diagnostic imaging revealed abnormal diaphragmatic findings and confirmed gastric volvulus.
- The patient had a perforated gastric volvulus, a rare and life-threatening complication.
Findings:
- The patient underwent emergent surgery for reduction of the gastric volvulus.
- Surgical repair included closure of the perforated stomach and plication of the diaphragm.
- A gastrostomy tube was placed during the procedure.
Implications:
- This case underscores the importance of considering gastric volvulus in older patients with diaphragmatic abnormalities and gastrointestinal symptoms.
- Prompt diagnosis and surgical management are crucial for favorable outcomes in complicated diaphragmatic eventration.
- Early recognition and intervention can prevent severe complications like gastric perforation and improve patient survival rates.
Abstract:
Bilateral congenital eventration of the diaphragm almost uniformly presents in infancy with respiratory compromise and is associated with a high mortality rate. Delayed presentation of diaphragmatic eventration in older children and adults may be associated with acute gastric volvulus. Thus, any patient with abdominal pain, vomiting, or nonspecific gastrointestinal symptoms in association with abnormal diaphragmatic findings on chest x-ray should undergo further diagnostic workup with upper gastrointestinal series or computed tomography (CT) scan. Treatment of gastric volvulus requires immediate surgical repair to prevent subsequent necrosis and perforation. The authors describe a case report of bilateral congenital diaphragmatic eventration complicated by a perforated gastric volvulus in a 13-year-old boy. Emergent reduction of the volvulus, closure of the perforated stomach, plication of the diaphragm, and placement of gastrostomy was performed successfully.