Emergent Bedside Thoracotomy for Decompression of an Incarcerated Neonatal Bochdalek Hernia: A Case Report

Congenital diaphragmatic hernia (CDH) is a rare and potentially life-threatening condition caused by incomplete diaphragm formation, allowing abdominal organs to herniate into the thoracic cavity. This typically results in pulmonary hypoplasia and, rarely, cardiac compression with subsequent cardiopulmonary collapse. We report the emergency management of a three-week-old term neonate with a previously undiagnosed left-sided Bochdalek hernia who presented at an external hospital with cardiac arrest and mediastinal shift due to massive obstructing enterothorax. Following stabilization and transfer to our hospital, a second cardiac arrest occurred in our neonatal intensive care unit (NICU). During cardiopulmonary resuscitation (CPR), an emergent bedside thoracotomy was performed, decompressing the thoracic cavity by exposing incarcerated bowel to the atmosphere, which led to the return of spontaneous circulation. Subsequent laparotomy revealed a small left-sided diaphragmatic defect with incarcerated bowel. CDH repair and temporary abdominal wall closure using a silo patch were performed. Secondary closure was achieved 5 days later. The patient was discharged without complications. This case highlights emergent bedside thoracotomy as a life-saving intervention in critical neonatal CDH.