title: Gastric volvulus complication in an infant with undiagnosed congenital diaphragmatic hernia presenting with acute respiratory distress.
abstract: BACKGROUND
  Congenital diaphragmatic hernia is an embryologic defect that creates a passage for herniation of abdominal structures into the thoracic cavity. This can lead to a variety of complications, including gastric volvulus that can present acutely with epigastric distention and vomiting. In cases of late-onset congenital diaphragmatic hernia, symptoms may be vague and often necessitate further investigation.
  
  
  METHODS
  Our patient is a 12-month-old previously healthy female infant who presented to the emergency department with a history of vomiting and acute onset respiratory distress. Her SaO(2) was 94% to 98% on room air, her respiratory rate was in the 80s breaths per minute, and she was noted to have severe retractions. Her chest examination revealed absent breath sounds on the left side. Her abdominal examination was unremarkable. The acute presentation of respiratory distress was initially concerning for a foreign body aspiration, but a chest radiograph demonstrated left-sided opacification and mediastinal shift to the right. The patient required intubation for respiratory decompensation and a subsequent computed tomographic scan showed diaphragmatic hernia with gastric volvulus.
  
  
  CONCLUSIONS
  This patient's presentation highlights one of the complications that may occur owing to congenital diaphragmatic hernia. Computed tomographic scan is the confirmatory test for diaphragmatic hernia and, in this case, also uncovered a concomitant gastric volvulus. Treatment includes early resuscitation, a definitive airway, and emergent surgery to prevent ischemic necrosis of the stomach owing to strangulation, gastric perforation, and serious cardiorespiratory decompensation.
authors.affiliation: School of Medicine, Southern Illinois University, Springfield, IL, USA.
authors.forename: Traci E
authors.initials: TE
authors.lastname: Ito
authors.forename: Rubab
authors.initials: R
authors.lastname: Hasnie
authors.forename: Dana L
authors.initials: DL
authors.lastname: Crosby
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Milbrandt
authors.forename: Sandra
authors.initials: S
authors.lastname: Ettema
authors.forename: Myto
authors.initials: M
authors.lastname: Duong
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D013902:Radiography, Thoracic; D013277:Stomach Volvulus / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed