Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication

Abstract

HighlightsCDH after neonatal period can present with wide array of clinical symptoms which often lead to delay in diagnosis and even misdiagnosis resulting in significant morbidity and potentially fatal outcomes.Interventions with misdiagnosis may result in iatrogenic complications which further increase morbidity and can even result in unwarranted mortality.When patient presents with recurrent non-specific respiratory or gastrointestinal tract symptoms, CDH should always be considered in differential diagnosis.Chest X-ray with nasogastric tube insertion, contrast enhanced CT scan and barium studies pave the way to correct diagnosis decreasing the morbidity and potential mortality due to CDH.

Dual Chest Pathology Presenting with Acute Respiratory Failure: A Case Report and Review of Literature

“…The CDH was diagnosed only by CT scan chest [10]. Similar articles described the same presentation [11][12][13]. Also, Blood et al describes a case of Morgagni hernia presented with intestinal malrotation.…”

“…Also, they cited a study conducted at 2019 at a high-volume center in the Netherlands between 2000 and 2015 consisting of retrospective analysis of 197 patients with CDH finding malrotation in 76 patients (39%) with higher incidence of bowel herniation in the malrotation group [2]. Pradeep et al described a case of lately presented CDH with iatrogenic gastric perforation by chest tube insertion on assumption of left sided pyothorax [13]. Similar cases have been reported with chest tube insertion leading to iatrogenic perforation in patients with undiagnosed diaphragmatic hernia [14,15].…”

Acute Respiratory Distress in a Two-month-old Female

“… 7 In patients with respiratory failure, treatment is provided with gentle, supportive respiratory support (while carefully avoiding further lung injury) and gastric decompression via nasogastric tube. 8 After stabilization or if the patient has acute abdominal symptoms, the patient is referred for surgical intervention. 7 Late presenting CDH patients tend to have a better long-term prognosis as they do not typically exhibit pulmonary hypoplasia or pulmonary hypertension.…”

Late-presenting Congenital Diaphragmatic Hernia: Case Report

“…10 Pnömotoraks, pyotoraks gibi hastalıklardan dikkatli ayırıcı tanı yapılması gereksiz cerrahi müdahalelerin önüne geçilmesi ve olguların komplike olmasının önlenmesi açısından önemlidir. 11,12 Bizim hastamızın da çekilen akciğer filminde sol hemitoraksta opasite, şüpheli barsak ansı görünümü ve mediastende sağa kayma mevcut idi. Toraks USG ve toraks BT çekilerek ayırıcı tanı yapıldı.…”