EC Paediatrics

Background: Congenital diaphragmatic hernia (CDH), also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Intrathoracic gastric perforation revealing a CDH in pediatrics is very rare.

Aim: Aim to report a case of gastric perforation revealing CDH.

Case Report: A 4-year-old girl, without any history of neonatal respiratory distress or any trauma, presented abdominal pain and vomiting for 3 days, with a rapid worsening of acute dyspnea. A physical exam showed diffuse abdominal distention, defense, and contraction. The chest X-ray showed pneumoperitoneum and an ascending gastric air sac. Thoraco-abdomino-pelvic CT scan showed gastric volvulus complicating left CDH. Laparotomy showed a large Bochdalek foramen at the left hemidiaphragm with gastric perforation; the spleen, left colon, and left kidney were in the hemithorax. The patient´s outcome was favorable.

Conclusion: Congenital diaphragmatic hernia complicated by perforated gastric volvulus should be considered a diagnostic and therapeutic emergency due to the risk of life-threatening gastric necrosis.

 Keywords: Congenital Diaphragmatic Hernia; Bochdalek; Late Revelation; Laparotomy; Gastric Volvulus; Gastric Perforation

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