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.
Rubin
Sylvain
S
CHU de Reims, Hôpital Robert Debré, Service de Chirurgie Thoracique et Cardiovasculaire, F-51092 Reims Cedex, France. srubin@chu-reims.fr
Sandu
Sebastien
S
Durand
Emmanuel
E
Baehrel
Bernard
B
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