Congenital Diaphragmatic Hernia As a Cause of Cardiorespiratory Failure and Visceral Obstruction in Late Pregnancy

Abstract

Background. Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken.

Case presentation. A woman at 23 week gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdaleks hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. Postoperative period was uncomplicated. Pregnancy was allowed to continue until 39 weeks gestation at which time elective cesarean delivery was performed.

Conclusion. Symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.