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Congenital hemidiaphragmatic agenesis presenting as reversible mesenteroaxial gastric volvulus and diaphragmatic hernia: a case report.

Sung HY, Cho SH, Sim SB, Kim JI, Cheung DY, Park SH, Han JY, Lee SM, Noh CH, Park YB, Jung SE, Lee SH, Choi KY - J. Korean Med. Sci. (2009)

Bottom Line: There were no diaphragmatic remnants visible for reconstruction of the left diaphragm.We provided warm saline irrigation and performed a left lower lobe adhesiotomy.Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

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Related in: MedlinePlus

Chest radiographies. (A) There was no abnormal finding reported on from the local clinic 4 days before admission. (B) On admission, gastric air-fluid and bowel loops were observed in the left thoracic cavity and a coiled nasogastric tube was seen in the stomach. (C) The herniation improved but haziness was still seen at the left lower lobe after surgical intervention.
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Figure 1: Chest radiographies. (A) There was no abnormal finding reported on from the local clinic 4 days before admission. (B) On admission, gastric air-fluid and bowel loops were observed in the left thoracic cavity and a coiled nasogastric tube was seen in the stomach. (C) The herniation improved but haziness was still seen at the left lower lobe after surgical intervention.

Mentions: A 70-yr-old woman, previously in good health was transferred to our hospital with the history of left sided chest pain, non-bilious vomiting and shortness of breath for four days. Six days before admission, the patient had a routine health check-up including chest radiography and upper gastrointestinal study (UGIS) using a gastric bloating agent at a local clinic. According to the referring clinic, the chest radiography and UGIS were normal (Fig. 1A, 2A). However, after taking the gastric bloating agent the patient developed increasing epigastric pain and nausea.


Congenital hemidiaphragmatic agenesis presenting as reversible mesenteroaxial gastric volvulus and diaphragmatic hernia: a case report.

Sung HY, Cho SH, Sim SB, Kim JI, Cheung DY, Park SH, Han JY, Lee SM, Noh CH, Park YB, Jung SE, Lee SH, Choi KY - J. Korean Med. Sci. (2009)

Chest radiographies. (A) There was no abnormal finding reported on from the local clinic 4 days before admission. (B) On admission, gastric air-fluid and bowel loops were observed in the left thoracic cavity and a coiled nasogastric tube was seen in the stomach. (C) The herniation improved but haziness was still seen at the left lower lobe after surgical intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698203&req=5

Figure 1: Chest radiographies. (A) There was no abnormal finding reported on from the local clinic 4 days before admission. (B) On admission, gastric air-fluid and bowel loops were observed in the left thoracic cavity and a coiled nasogastric tube was seen in the stomach. (C) The herniation improved but haziness was still seen at the left lower lobe after surgical intervention.
Mentions: A 70-yr-old woman, previously in good health was transferred to our hospital with the history of left sided chest pain, non-bilious vomiting and shortness of breath for four days. Six days before admission, the patient had a routine health check-up including chest radiography and upper gastrointestinal study (UGIS) using a gastric bloating agent at a local clinic. According to the referring clinic, the chest radiography and UGIS were normal (Fig. 1A, 2A). However, after taking the gastric bloating agent the patient developed increasing epigastric pain and nausea.

Bottom Line: There were no diaphragmatic remnants visible for reconstruction of the left diaphragm.We provided warm saline irrigation and performed a left lower lobe adhesiotomy.Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
A 70-yr-old woman complained of left sided chest pain and non-bilious vomiting for four days after taking a gastric bloating agent for an upper gastrointestinal study. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. An emergency thoracotomy was performed. The abdominal organs (stomach, spleen, splenic flexure of the colon) were in the left thorax and the entire left hemidiaphragm was absent. There were no diaphragmatic remnants visible for reconstruction of the left diaphragm. We provided warm saline irrigation and performed a left lower lobe adhesiotomy. Thirteen days after surgery, the chest radiography showed improvement in the herniation but mild haziness remained at the left lower lung field. Here we present the oldest case of congenital diaphragmatic agenesis presenting with transient gastric volvulus and diaphragmatic hernia.

Show MeSH
Related in: MedlinePlus