A late post-traumatic diaphragmatic hernia revealed during pregnancy by post-partum respiratory distress.
BACKGROUND
Diaphragmatic hernia during pregnancy is uncommon and is usually traumatic in origin, epigastric pain, and vomiting could be the initial symptoms of herniation of gastrointestinal contents, with a risk of strangulation and ischaemia, leading to respiratory distress due to collapse of the lung.


METHODS
Case report.


RESULTS
A 27-year-old woman, with undiagnosed traumatic diaphragmatic hernia who presented, at 32 weeks' gestation, epigastric pain, vomiting and tachycardia, immediate post-partum course was complicated by respiratory failure. A chest X-ray showed an air fluid level in the left lung which was wrongly diagnosed as an hydropneumothorax, in front of respiratory symptoms exacerbation, an inappropriate thoracic drainage tube was accidentally placed into the herniated stomach leading to perforation of this last. An emergency laparotomy discovered a 2/3 of the stomach, transverse colon and greater omentum herniated in the left hemithorax through a defect of the left hemidiaphragm.


CONCLUSIONS
The diagnosis should then be considered early, and chest radiography with a nasogastric tube is the first technique to prefer and may be helpful to confirm the diagnosis.
Rifki Jai
Saâd
S
Department of Surgery III, Ibn Rochd University Hospital, Casablanca, Morocco. saadjai@yahoo.fr
Bensardi
Fatimazahra
F
Hizaz
Ahmed
A
Chehab
Farid
F
Khaiz
Driss
D
Bouzidi
Abdelmajid
A
D000328:Adult; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors