Laparoscopic Repair of a Chronic Iatrogenic Diaphragmatic Hernia

Short bowel syndrome as an unusual complication of strangulated congenital diaphragmatic hernia: Case report

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Congenital diaphragmatic hernia is a rare cause of neonatal bowel obstruction.

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Congenital diaphragmatic hernia is associated with many long-term complications involving multiple systems.

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Only few cases in the literature has reported a strangulated congenital diaphragmatic hernia and even a fewer ones required bowel resection.

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Short bowel syndrome is an unlikely outcome of strangulated congenital diaphragmatic hernia, requiring feeding by total parenteral nutrition.

Introduction

Strangulation is a rare complication of congenital diaphragmatic hernia (CDH). There are few cases in the literature describing strangulated CDH. However, none of them was a recurrence of a previously repaired defect nor resulted in short bowel syndrome.

Presentation of case

We report an unusual case of newborn presenting with CDH that was repaired shortly after birth but developed recurrence with strangulation few months after, requiring a massive resection, resulting in short bowel syndrome (SBS). It was managed via total parenteral nutrition feeding for three months until the patient was able to tolerate orally.

Discussion

There were one familiar case in the reported literature by Woolley of an infant developing bowel infraction as a result of CDH where he later developed short bowel syndrome.

Conclusion

Short bowel syndrome is an unlikely outcome of strangulated CDH. Early repair of the defect should be promoted to avoid the devastating consequences of an CDH similar to the ones encountered in our case. High index of suspicion should be kept during the follow-up of patients with CDH post repair to detect early signs of recurrences.

Congenital diaphragmatic hernia: review of current concept in surgical management

CONGENITAL DIAPHRAGMATIC HERNIAS (CDHS) OCCUR MAINLY IN TWO LOCATIONS: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.