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
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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: [email protected]
© 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
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