EN
TÜRKÇE
Poster - 19
A GASTRIC VOLVULUS IN CONGENITAL DIAPHRAGMATIC HERNIA. A CASE REPORT
N CHENIKI
UNIVERSITY OF MEDICINE ORAN1.ALGERIA
Congenital diaphragmatic hernia is an anomaly that often manifests in the neonatal period with respiratory distress.
Late presentations are usually gastrointestinal in nature and may sometimes reveal severe complications.
Intrathoracic gastric ascent is frequently associated with volvulus, which, if not managed promptly, can be fatal.
CASE DESCRIPTION
A 15-year-old adolescent with no prior medical history presented to the emergency department with:
- Moderate general condition, pallor, sweating, dyspnea, vomiting, and epigastric pain.
Chest X-ray revealed a large air-fluid level in the left thoracic cavity without visualization of the gastric air bubble.
Given the rapid deterioration of the patient's condition, emergency surgery was performed with a presumed diagnosis of gastric volvulus due to congenital diaphragmatic hernia.
Intraoperative exploration confirmed the diagnosis.
The procedure involved detorsion, gastric reduction, and closure of the diaphragmatic defect.
The patient was able to resume oral feeding on postoperative day 2 and was discharged on day 5.
A 5-year follow-up showed no recurrence.
DISCUSSION
Gastric volvulus is a relatively common complication associated with congenital diaphragmatic hernia, occurring in up to 42% of cases in some studies.
It results from a ligamentous defect of the stomach, primarily involving the gastrophrenic and gastrosplenic ligaments.
Radiological findings typically show a large air-fluid level. Contrast studies and thoracoabdominal CT scans can confirm the diagnosis but may delay management in cases of complications.
Delayed treatment can lead to strangulation, gastric overdistension, necrosis, and perforation.
CONCLUSION
Gastric volvulus associated with congenital diaphragmatic hernia is a diagnostic and therapeutic emergency.
It should be suspected based on clinical presentation and chest X-ray findings.
Surgical intervention must be performed without delay to prevent fatal complications.