title: Congenital diaphragmatic hernia complicated by tension gastrothorax during gastroscopy: report of a case.
abstract: Bochdalek's hernia typically manifests early in childhood, but it is uncommon in adults. We report the case of a 77-year-old woman who suffered sudden acute cardiorespiratory distress during an upper gastro-intestinal endoscopy, caused by a massive gastrothorax, confirmed by a chest radiograph and thoracic computed tomography. Laparotomy revealed a posterolateral diaphragmatic defect and an acutely distended stomach occupying the left hemithorax, caused by an incomplete organoaxial volvulus of the organ. The stomach was reduced and secured inside the abdominal cavity by a Nissen fundoplication and the defect was repaired with interrupted sutures. Unfortunately, the patient succumbed to generalized sepsis resulting from Pneumocystis carinii bilateral pneumonia. To our knowledge, this is the first reported case in the English literature of an adult with a congenital posterolateral hernia presenting in this manner. However, it demonstrates that a symptomatic congenital diaphragmatic hernia should be surgically repaired to prevent the numerous complications that may arise, many of which can prove fatal even in an adult.
authors.affiliation: Department of Surgery, Thriassion General Hospital, 18 Levidiou Street, 131.21 Ilion, Athens, Greece.
authors.forename: Anestis
authors.initials: A
authors.lastname: Ninos
authors.forename: Evagelos
authors.initials: E
authors.lastname: Felekouras
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Douridas
authors.forename: Enkel
authors.initials: E
authors.lastname: Ajazi
authors.forename: Anna
authors.initials: A
authors.lastname: Manataki
authors.forename: Stefanos
authors.initials: S
authors.lastname: Pierrakakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Setakis
mesh_terms: D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology*; D013277:Stomach Volvulus / Q000209:etiology*