Diaphragmatic rupture during labour, two years after an intra-oesophageal rupture of a bronchogenic cyst treated by an omental wrapping.
We report the case of a 27-year-old pregnant woman, presenting a rare but potentially fatal complication of an omental wrapping, transposed in the thorax by a phrenotomy due to an intra-oesophageal rupture of a bronchogenic cyst. Two years later, on time of delivery of her first pregnancy, she has presented a diaphragmatic rupture with a complete transposition of the volvuled stomach. The diagnosis was done using the Gastrographin transit and the CT-scan, showing the specific 'Collar sign'. An urgent surgical correction was performed including the re-instatement of all abdominal organs in the peritoneum, the omental wrapping section and the diaphragmatic closure. The two-year follow-up was uneventful. We discuss the case, the investigations needed and the possibility to cut the omental wrapping without any complication two years after this oesophageal re-inforcement. In conclusion, we believe that omental transpositions must always be done using the retrosternal route or by transhiatal approach to avoid this serious complication after delivery.
CHU de Reims, Hôpital Robert Debré, Service de Chirurgie Thoracique et Cardiovasculaire, F-51092 Reims Cedex, France. srubin@chu-reims.fr
Sylvain
S
Rubin
Sebastien
S
Sandu
Emmanuel
E
Durand
Bernard
B
Baehrel
D000328:Adult; D001994:Bronchogenic Cyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008476:Mediastinal Cyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009852:Omentum / Q000637:transplantation*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D012086:Reoperation; D012421:Rupture; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed