Journal of Neonatal Surgery 2012;1(2):29

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C A S E R E P O R T

EVENTRATION OF DIAPHRAGM WITH HIATAL HERNIA: A CASE REPORT

Bilal Mirza,* Afzal Sheikh

Department of Pediatric Surgery, The Children’s Hospital and the Institute of Child Health Lahore, Pakistan

* Corresponding Author

Available at http://www.jneonatalsurg.com

This work is licensed under a Creative Commons Attribution 3.0 Unported License

How to cite:

Mirza B, Sheikh A. Eventration of diaphragm with hiatal hernia: a case report. J Neonat Surg 2012; 1: 29

ABSTRACT

A 25-day-old female baby having eventration of diaphragm associated with a big hiatal hernia is being

reported here. This is the second report describing the rare association.

Key words: eventration of diaphragm, hiatal hernia

INTRODUCTION

Hernia, eventration, and agenesis are the main congenital

birth defects that affect diaphragm. Congenital diaphrag-

matic hernia is the frequent defect [1]. These defects usual-

ly occur in isolation and rarely coexist. A single report is

available regarding the association of eventration and hiatal

hernia in human beings [2]. We are reporting the second

report on this rare association.

CASE REPORT

A 25-day-old neonate, weighting 3kg, presented with non-

bilious vomiting for 2 weeks and respiratory distress for a

week. He was a product of consanguineous marriage and

born by spontaneous vaginal delivery with no perinatal prob-

lems. On clinical examination the patient was tachypneic

(respiratory rate 55/min), with temperature 99F and heart

rate of 120/min. Chest auscultation showed reduced air

entry on posterior aspects of right lower chest. Chest radio-

graph was performed that showed right eventration of dia-

phragm (Fig. 1).

Patient was stabilized by oxygen inhalation, steam nebuliza-

tion, and antibiotics. Operation was performed that revealed

a small eventration of diaphragm not coinciding with the

radiographic delineation. Further exploration revealed ab-

sent stomach in the peritoneal cavity which was entirely

present in the chest across a big hiatal hernia (Fig. 2,3). The

stomach was retrieved back to the peritoneal cavity and hia-

tal hernia was repaired after excising the hernia sac.

Eventration of diaphragm was also repaired. The postopera-

tive recovery was uneventful. Postoperative chest radiograph

was indicative of proper repair of the defects. The patient is

doing well on follow up.

DISCUSSION

In the present case the big hiatal hernia was simulating an

eventration of left hemi-diaphragm, nevertheless the

eventration was also present. Inspection of hiatus is neces-

sary if one finds incommensurately small eventration as to

the radiographic delineation. In our case a small eventration

was there; on further exploration stomach was not present

within the abdomen. Therefore hiatus was inspected and

entire stomach was delivered out of the chest, followed by its

repair. A 5% rate of fatal complications related to big hiatal

hernia are reported; incarceration, gastric perforation and

Eventration of diaphragm with hiatal hernia: a case report

Journal of Neonatal Surgery Vol. 1(2); 2012

volvulus are the most dreadful ones [3]. In the first report of

this rare association, the hiatal hernia was missed during

first operation that led to gastric volvulus and thus required

an emergent surgery [1]. Therefore we recommend inspecting

the hiatus in all types of diaphragmatic repairs in order to

avoid sinister complications.

Figure 1: X-ray chest showing eventration of diaphragm.

Figure 2: A small eventration

Figure 3: A big hiatal hernia causing herniation of entire

stomach into chest.

REFERENCES

1. Mirza B, Bashir Z, Sheikh A. Congenital right hemidiaphragmatic agenesis. Lung India. 2012; 29: 53-5.

2. Al-Arfaj AA, Chirurgie AF, Khwaja MS, Mitra DK. Congeni-tal diaphragmatic eventration associated with massive hia-tal hernia. Indian J Pediatr. 2005; 72: 181.

3. Sihvo EI, Salo JA, Rasanen JV, Rantanen TK. Fatal com-

plications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg. 2009; 137: 419-24.

Address for correspondence

Dr Muhammad Bilal Mirza

H/No. 428 Nishter Block Allama Iqbal Town Lahore, Pakistan

E mail: blmirza@yahoo.com

© Mirza et al, 2012

Submitted on: 25-02-2012

Accepted on: 11-03-2012

Published on: 01-04-2012

Conflict of interest: None

Source of Support: Nil