Complicated diaphragmatic hernia post laparoscopic Nissen fundoplication: a case report

Area of Science:

• Pediatric Surgery
• Gastroenterology

Background:

• Gastroesophageal reflux disease (GERD) definition involves reflux with symptoms or complications.
• Diagnosing GERD prevalence is challenging due to subjective symptom perception.
• Gastric volvulus and wrap migration are known Nissen fundoplication complications, but diaphragmatic defects present unique risks.

Purpose of the Study:

• To report a rare case of gastric volvulus following laparoscopic Nissen fundoplication in a pediatric patient.
• To highlight the importance of identifying diaphragmatic defects during surgery.

Main Methods:

• Case presentation of a 4-year-old child with shock and abdominal rigidity post-laparoscopic Nissen fundoplication.
• Diagnostic imaging including X-ray and CT scan revealed herniated stomach, ischemic volvulus, and pneumoperitoneum.
• Surgical exploration and successful management of the complication.

Main Results:

• A rare complication of gastric volvulus with ischemic changes and pneumoperitoneum was identified.
• The herniation was attributed to a diaphragmatic defect medial to the hiatus.
• The patient was successfully managed through surgical intervention.

Conclusions:

• Gastric volvulus is a high-morbidity/mortality complication of laparoscopic fundoplication that can be missed.
• A high index of suspicion is essential for diagnosing post-operative gastric volvulus.
• Careful intraoperative inspection of the diaphragm for defects is critical to prevent such severe complications in pediatric patients.