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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

CT finding at the level of the lower thorax demonstrating normal right (arrow) and absent left hemidiaphragm and loops of bowel in left thorax.
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Figure 3: CT finding at the level of the lower thorax demonstrating normal right (arrow) and absent left hemidiaphragm and loops of bowel in left thorax.

Mentions: On admission, the respiratory rate of the patient was 38 breaths/min and the oxygen saturation was 91% in room air. Physical examination showed absent breath sounds and dull to percussion findings at the left lung base. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. After the placement of a nasogastric tube, the chest radiography showed displacement of the tip of the tube to the dilated stomach located in the left thoracic cavity (Fig. 1B). An UGIS using gastrograffin was performed without a bloating agent (Fig. 2B). The UGIS showed no transit of the gastrograffin through the duodenum and a hook-like image was noted at the medial portion of the herniated stomach. A chest CT revealed absence of the left side of the diaphragm (Fig. 3). The impression was that the patient had a mesenteroaxial gastric volvulus with a diaphragmatic hernia. The patient underwent surgical exploration.


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)

CT finding at the level of the lower thorax demonstrating normal right (arrow) and absent left hemidiaphragm and loops of bowel in left thorax.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: CT finding at the level of the lower thorax demonstrating normal right (arrow) and absent left hemidiaphragm and loops of bowel in left thorax.
Mentions: On admission, the respiratory rate of the patient was 38 breaths/min and the oxygen saturation was 91% in room air. Physical examination showed absent breath sounds and dull to percussion findings at the left lung base. The chest radiography revealed gastric air-fluid levels and bowel loops in the left thoracic cavity. After the placement of a nasogastric tube, the chest radiography showed displacement of the tip of the tube to the dilated stomach located in the left thoracic cavity (Fig. 1B). An UGIS using gastrograffin was performed without a bloating agent (Fig. 2B). The UGIS showed no transit of the gastrograffin through the duodenum and a hook-like image was noted at the medial portion of the herniated stomach. A chest CT revealed absence of the left side of the diaphragm (Fig. 3). The impression was that the patient had a mesenteroaxial gastric volvulus with a diaphragmatic hernia. The patient underwent surgical exploration.

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