A case of congenital diaphragmatic hernia due to left central tendon defect in pregnancy
Fujita, Y.; Hirono, T.; Koike, T.; Yamato, Y.; Okawa, A.; Eguchi, S.
Nihon Kyobu Geka Gakkai 37(7): 1426-1429
1989
ISSN/ISBN: 0369-4739 PMID: 2794605 Document Number: 342134
A twenty-seven-years-old 25 weeks gestation female was admitted with recurrent symptoms of nausea, vomiting and epigastric pain. She was diagnosed as left diaphragmatic hernia by chest X-ray film, CT and esophago-gastrography. During operation, a left central tendon defect was observed, and was 3.5 cm in diameter. The margin of the defect was smooth and round. It was associated with diaphragmatic eventration. The small intestine and transverse colon were herniated into the left throacic cavity. The central tendon defect was closed with direct mattress sutures and was reinforced by overlap-technique of the diaphragm. To our knowledge, this type of defect has not been described previously in Japan. Diaphragmatic hernia in pregnancy is very rare, and presents abdominal pain, vomiting and dyspnea. Usually the diagnosis is achieved by chest X-ray film. However, esophagogastrography should be added, if the diagnosis could not be confirmed by chest X-ray film. Conservative management is reported to bring high mortality, therefore, prompt surgical repair is advisable.