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Axial computed tomography without contrast. The herniation of abdominal contents through the posterior margin of the left hemidiaphragm is shown. White arrow: intrathoracic location of the gastric chamber surrounded by infiltrated fat. Black arrows point at air bubbles suggesting gastric perforation.
Source publication
Simultaneous gastric and diaphragmatic rupture is an exceptional situation during pregnancy and it implies a high-risk of maternal and fetal mortality. They are usually associated with previous diaphragmatic abnormalities such as diaphragmatic hernia or diaphragmatic eventration. Both gastric and diaphragmatic rupture can be triggered by situations...
Context in source publication
Context 1
... emesis gravidarum treated suc- cessfully before the 10th week. A simple chest X-ray at admission revealed a left hydro- pneumothorax that was drained obtaining 4200 cm of clear 3 and transparent liquid. Tomography scan results indicated presence of herniation of abdominal contents through the posterior margin of the left hemidiaphragm (Fig. ...
Citations
... However, four cases were primigravida with no symptoms before pregnancies: Two cases of maternal BH surgically repair in the neonate period [20,28], and two cases of maternal BH incidentally recognized through chest X-rays five years and several years earlier, respectively [31,33]. ...
... Fetal radiation exposure from an abdominal/pelvis CT is 2.5 rad (25 mGy). CT can evaluate the maternal abdomen by performing a relatively high pitch and relatively thick slice (7-10 mm) to minimize any risk [22,28,30,31,34,36,40,41,43,45,60], but imaging should be performed only if the benefits of diagnosis exceed the theoretical risk of fetal exposure. ...
Background:
Since the first report of a diaphragmatic hernia from Ambroise Paré's necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early.
Data sources and study selection:
A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups' presence due to their rarity.
Results:
The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases.
Conclusion:
Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.
... Stomach rupture can be caused by excessive intake of fluids, supplemental oxygen via nasal cannula or pyloric obstruction. 3 ...
... It can lead to respiratory problems, intestinal rupture, and death. 3 Gastric perforation can be characterized by increased ...
This report presents a case of diaphragmatic and stomach rupture in a 30‐week pregnant woman. Timely diagnosis and management of the rupture is important to reduce systemic complications and effects on the mother and fetus. Symptoms and signs should be clearly studied to prevent misdiagnosis and delay in the treatment. This report presents a case of diaphragmatic and stomach rupture in a 30‐week pregnant woman. Timely diagnosis and management of the rupture is important to reduce systemic complications and effects on the mother and fetus. Symptoms and signs should be clearly studied to prevent misdiagnosis and delay in the treatment.
... Our literature review identified 56 cases of maternal diaphragmatic hernias presenting in pregnancy. Of the 56 cases identified, 54% presented after 24 weeks gestation, [1, 21% prior to 24 weeks, [2,23,[29][30][31][32][33][34][35][36][37][38], 20% during labour or postpartum [33,[39][40][41][42][43][44][45][46][47][48] and 5% did not report gestation. The patients predominantly reported symptoms of abdominal or chest pain (84%), vomiting (60%) and dyspnoea (41%). ...
Background
Maternal diaphragmatic hernias identified during pregnancy are rare and pose significant management challenges with regards to timing and mode of both delivery and hernia repair. Case presentationWe describe a case of a maternal diaphragmatic hernia diagnosed at 31 weeks gestation in the setting of acute upper abdominal pain. Due to no evidence of visceral compromise and a stable maternal condition, the patient was conservatively managed, allowing for further foetal maturation. Delivery by caesarean section occurred following concerns of malnutrition and partial bowel obstruction. This was followed by immediate surgical repair of the hernia. The patient had an uncomplicated recovery. Conclusion
Maternal diaphragmatic hernias in pregnancy require multidisciplinary care and individualised management in order to allow for the optimal outcome for mother and foetus.
... For this reason, we should consider gastrointestinal and respiratory system pathologies after ruling out the obstetric causes in patients presenting with similar complaints. There are cases in the literature that culminate in gastric and diaphragmatic ruptures [5]. The mortality rate in such cases is quite high. ...
Diaphragmatic eventration is a permanent elevation of part or all of the dia-phragmatic leaf. The patient had progressive dyspnea and dyspeptic complaints at gestational week 35. She was followed up with a presumed diagnosis of dia-phragmatic eventration. We present here our intervention in a case where cesar-ean section was performed at gestational week 38 due to progressive dyspnea. Diaphragmatic eventration should be considered after obstetric causes are ruled out in patients who present with non-specific symptoms regardless of their gesta-tional week. The treatment approach should be multidisciplinary, involving gyne-cologists, obstetricians, pediatricians, and pulmonologists, as well as specialists from other branches when necessary. © 2016, Journal of Clinical and Analytical Medicine. All rights reserved.
... Gastrothorax is either due to congenital or longstanding diaphragmatic hernia and is almost always in pregnant females. NGT decompression of the stomach is very helpful (1)(2)(3)(4)(5)(6)(7)(8). Tension gastrothorax may be due to congenital diaphragmatic hernias, chest tube malinsertions, laparoscopic cholecystectomy, microwaveassisted laparoscopic hepatectomy, laparoscopic gastric banding and plication for eventration of the diaphragm. ...
Introduction:
The presence of the stomach in the chest is called gastrothorax. Few cases were reported. Most of them were related to congenital diaphragmatic hernia.
Objectives:
We are presenting a case of successful repair of ruptured traumatic gastrothorax which was masqueraded as chylothorax.
Methods:
A male patient with rupture stomach in the left chest cavity. Results successful repair of ruptured traumatic gastrothorax.
Conclusion:
Traumatic ruptured gastrothorax can be mistaken for chylothorax.
... Ruptures during this period with rapid increase in the uterine size are documented [10]. If it happens during pregnancy, the mortality of mother and fetus is really higher as after childbirth [11,12]. Thereby it would be judicious to diagnose and to treat diaphragmatic hernias in women in child-bearing age before pregnancy in matter to avoid potential lethal complications for the expectant mother and her fetus. ...
... Increased intraabdominal pressure (such as in strenuous exercise, obesity or pregnancy) may cause exaggeration of symptoms (1)(2)(3)(4)(5). Diaphragmatic rupture, gastric rupture, acute or chronic gastric or splenic flexure volvulus may rarely occur (6)(7)(8)(9)(10). ...
Diaphragmatic eventration is a rare congenital developmental defect of the muscular portion of the diaphragm, which appears attenuated and membranous, maintaining its normal attachments and its anatomical continuity. It has been attributed to abnormal myoblast migration to the septum transversum and the pleuroperitoneal membrane. Eventration can be unilateral or bilateral, partial or complete. It is more common in males, and involves more often the left hemidiaphragm. Eventration results in diaphragmatic elevation (cephalad displacement). Most adults are asymptomatic and the diagnosis is incidentally made by chest radiography. The commonest symptom in the adults is dyspnoea, while orthopnoea, mild hypoxemia, tachypnoea, respiratory alkalosis, palpitations, and non specific gastrointestinal symptoms may be present. Surgery is indicated only in the presence of symptoms. The established surgical treatment is diaphragmatic plication. Various techniques and approaches have been employed. We present a simple surgical technique of a 3-port video assisted thoracoscopic plication of the left hemidiaphragm in the adult.
... In addition, the absence of fever or cough helps differentiate DH from pneumonia or pleurisy. However careful history alone is critical to identifying women with DH, given that the majority of cases are associated with congenital DH or previous abdominal or chest wall trauma [3,4]. ...
Rupture of a maternal diaphragmatic hernia (DH) during pregnancy is a rare but significant complication. We describe a case of a maternal ruptured DH, presenting as acute postpartum dyspnea, which required urgent operative repair. We report our surgical strategy and review the key concepts in the multidisciplinary management of this condition.
... In addition, abdominal pain could also be related to other conditions due to strangulated DH, such as gastric necrosis [20] or perforation [21]. In some cases, diaphragmatic rupture could be complicated by a gastric rupture [22], which may present intense abdominal and/or chest pain. ...
Objective: Nausea and vomiting of pregnancy, the most common medical condition of pregnancy, affects up to 80% of all pregnancies to some extent, and hyperemesis gravidarum does less than 1% of pregnant women. When hyperemesis gravidarum induces diaphragmatic tear, diagnosis can be missed because of nonspecific presentation with abdominal pain, nausea and vomiting. Methods: We reported a pregnant case suffering from intractable vomiting at the beginning of the second trimester (the 13th week of gestation) with delayed diagnosis of diaphragmatic tearing. Results: The patient was misdiagnosed initially, which delayed the surgical intervention and unnecessary abortion. Conclusion: It is worthwhile considering the maternal diaphragmatic cause as an unusual one of refractory vomiting accompanied by clinically significant progressive epigastric pain, distension and respiratory embarrassment.
Background
Bochdalek hernia (BH) of congenital diaphragm hernia is infrequently seen in adults. Strangulation of the diaphragm hernia has been recognized as a severe complication. Among several factors, pregnancy is an important cause of diaphragm hernia’s deterioration. However, nausea, vomiting, and upper abdominal pain are often considered non-specific pregnancy-related symptoms.
Case Presentation
We report a case of a 39-year-old (gravida II, para I) multigravida woman with a delayed diagnosis of strangulated herniated viscera complicating total gastric gangrene at 26+1 weeks’ gestation. The preoperative diagnosis was confirmed by an X-ray examination and magnetic resonance imaging (MRI). After identifying the size and severity of the herniated contents through video-assisted thoracoscopy (VAT), we immediately converted to abdominal laparotomy. Antenatal corticosteroids were administered simultaneously with diagnosis to promote fetal maturity. The fetal condition was maintained well in the maternal uterus during the operation. Careful monitoring of the fetus and the mother’s clinical conditions should be performed during expectant management to achieve delayed delivery after maternal surgical correction. Delivery was completed through cesarean delivery at 27+1 weeks of gestation.
Conclusion
Despite the rarity of maternal Bochdalek hernias during pregnancy, early diagnosis and appropriate treatment via multidisciplinary care are essential for maternal and fetal outcomes.
