Congenital diaphragmatic hernia with recurrent gastric volvu
Gastric volvulus can be acute, acute on chronic or chronic, and may be primary or secondary to anomalies that affect the fixity of the stomach like hiatus hernia, eventration of diaphragm or congenital diaphragmatic hernia (CDH). The association of bronchopulmonary foregut malformations such as congenital cystic adenomatoid malformation of lung and bronchopulmonary sequestration (BPS) with CDH has also been well described in the literature. Herein, we describe a 4-year-old girl with a rare presentation of gastric volvulus and pulmonary sequestration in association with CDH.
A 4-year-old girl presented to our casualty with upper abdominal pain, distension, and nonbilious vomiting for the last two days. Her mother gave a history of recurrent episodes of similar symptoms every month for the last six months, and each episode lasted for 4-5 h.
The symptoms used to diminish spontaneously. Her perinatal history was unremarkable. A preliminary work up for her past symptoms in another hospital revealed that she had a suspected left sided eventration as seen on the chest X-ray. On examination, the child was lethargic, obtunded, had cold peripheries with tachycardia, hypotension, and feeble pulse. Her abdomen was distended, tense and tender especially in the upper half. A nasogastric tube insertion was attempted that failed initially but subsequently drained hemorrhagic gastric contents. A skiagram at this stage revealed a gastric bubble, with a paucity of distal bowel gas and a raised left hemi diaphragm....