Congenital Diaphragmatic Hernia Presenting with Tension Pneumothorax in a 3-Year-Old Boy

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Gastroenterology

Background:

• Congenital diaphragmatic hernia (CDH) is a rare birth defect where organs in the abdomen move into the chest through an opening in the diaphragm.
• Tension pneumothorax is a life-threatening condition caused by air accumulating in the chest cavity, leading to lung collapse and mediastinal shift.

Observation:

• A 3-year-old boy presented with respiratory distress, diagnosed with left-sided tension pneumothorax and suspected enterothorax.
• Imaging revealed herniation of abdominal viscera into the chest, and drained fluid matched nasogastric tube contents.
• Diagnostic laparoscopy confirmed a left-sided Bochdalek hernia with subsequent identification and repair of a gastric perforation.

Findings:

• The case highlights a rare etiology of tension pneumothorax in an infant: a combination of congenital diaphragmatic hernia and visceral hollow organ perforation.
• Surgical intervention involving organ repositioning and gastric repair was successfully performed.

Implications:

• This case underscores the importance of considering rare combined pathologies in pediatric respiratory emergencies.
• Early recognition and multidisciplinary management are vital for improving outcomes in complex congenital anomalies.
• Highlights the diagnostic challenge in differentiating primary respiratory issues from intrathoracic complications of abdominal pathologies.