Relapse of a false left-sided diaphragmatic hernia in a 2-year-old child complicated by strangulation and colon necrosis, cecum perforation and peritonitis

BACKGROUND: Despite the large number of works devoted to diaphragmatic hernia (DH) in children, this problem is still one of the most pressing in pediatric surgery. Diagnostics and treatment of DH complications still remains one of the most difficult tasks for pediatric surgeons dealing with complications. The most dangerous one is strangulation of the recurrent hernia which leads to stomach and intestine necrosis. Many researchers point out that diagnostics of strangulated diaphragmatic hernia is a difficult issue. One of the reasons for late diagnosis may be physicians' insufficient knowledge on specific features of clinical course of this disease. Intensive development of video endoscopic surgery in pediatric practice contributes to the active implementation of modern technologies on DH treatment, thus leading to much better outcomes.

CLINICAL CASE DESCRIPTION: The authors present a rare clinical case: a 3-day-old child survived thoracoscopic correction of congenital Bochdalek diaphragmatic hernia. After the surgery, paroxysmal abdominal pain and vomiting appears from time to time. The child was treated by various specialists who put various diagnosis: appendicitis, intestinal colic, and gastritis. After this ineffective treatment, the 2-year old child was admitted to the hospital where strangulation of a recurrent diaphragmatic hernia complicated by colon necrosis, perforation of the cecum and peritonitis were diagnosed. The child had a comprehensive management including laparotomy, colon resection with end-to-end anastomosis, plastic surgery of the diaphragm dome, suturing of cecum perforation and sanitation of the abdominal cavity. The postoperative period was without complications. The patient was discharged on day 12 in satisfactory condition. 10 month later, at the follow-up visit, the child was found healthy, no complaints.

CONCLUSION: Strangulated diaphragmatic hernia needs close attention because this pathology can lead to serious complications. Timely diagnostics and surgical treatment of congenital DH promote complete recovery and prevent complications.