Maternal Strangulated Diaphragmatic Hernia with Gangrene of the Entire Stomach During Pregnancy: A Case Report and Review of the Recent Literature

Tension pneumothorax from large bowel herniation and perforation as a late presentation of traumatic diaphragmatic hernia during pregnancy: a case report

BACKGROUND

Diaphragmatic hernias can be congenital or acquired, with trauma being the primary cause of the latter. Both types may have delayed presentations, with abdominal organs protruding into the thoracic cavity, causing symptoms of varying severity. Pregnancy can sometimes precipitate the condition. Tension pneumothorax resulting from bowel perforation into the thorax is exceptionally rare, with only a few cases reported. To the best of the authors knowledge, this is the third documented case of a late-presenting trauma-related diaphragmatic hernia during pregnancy, complicated by tension pneumothorax.

CASE PRESENTATION

A 30-year-old woman, 29 weeks pregnant, was referred to Semmelweis University emergency department with moderate dyspnea. Initial investigation revealed tension pneumothorax. Chest tube placement released air, pus, and feces. Computer tomography identified a diaphragmatic hernia with bowel incarceration and perforation as the underlying cause. The patient underwent a delayed cesarean section and surgical repair, with a good outcome. A history of thoracic trauma eight years prior was later revealed.

CONCLUSION

Evaluating pregnant patients with shortness of breath in the emergency department is challenging. Identifying a history of thoracic or abdominal trauma is crucial, as this can raise the suspicion of diaphragmatic hernia, which can present with a wide range of symptoms. Spontaneous tension pneumothorax in pregnant women is extremely rare and requires cautious management. A multidisciplinary approach is crucial for the successful treatment of maternal diaphragmatic hernia.

Diaphragmatic Rupture in the Postpartum Period

Diaphragmatic rupture during labor is an exceptionally rare condition, with a limited number of cases reported in the literature. A recent review underscores the rarity of this complication and emphasizes the associated challenges in diagnosis and management. This case report presents a postpartum diaphragmatic rupture, focusing on the diagnostic and therapeutic challenges it poses, particularly in the context of unsupervised deliveries. We report the case of a 32-year-old woman, with no significant medical history, who presented with intractable vomiting, and progressively worsening exertional dyspnea 30 days after a normal vaginal delivery. A chest X-ray revealed an air-filled space above the diaphragm, and an abdominal CT scan confirmed a diaphragmatic rupture with herniation of the stomach into the thoracic cavity, causing upward shifting of the cardiac chambers. The patient underwent emergency surgery via a midline supra-umbilical laparotomy. The herniated stomach was successfully repositioned into the abdominal cavity, the diaphragmatic defect was repaired, and an anti-reflux posterior hemivalve was created. Postoperative recovery was smooth, with significant improvement in clinical symptoms. This case highlights the importance of considering diaphragmatic rupture in postpartum women presenting with unexplained respiratory symptoms, particularly in settings where labor is not medically supervised. Rapid surgical intervention is crucial to prevent life-threatening complications and improve maternal outcomes.

A Rare Case of Diaphragmatic Rupture Due to Ectopic Pregnancy Leading to Haemorrhagic Shock in a Multipara: A Case Report

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy. Although the underlying mechanism of this abnormal disorder is unknown, a number of risk factors have been identified, including pelvic inflammatory disease, history of pelvic surgery, intrauterine device use and previous ectopic pregnancy. Diaphragmatic rupture due to ectopic pregnancy is a rare and life-threatening condition that can lead to massive intraperitoneal haemorrhage and haemorrhagic shock. This report presents the case of a 21-year-old woman who presented with 7 weeks and 4 days of amenorrhoea and 14 hours of acute abdominal pain. On examination, she was in haemorrhagic shock with signs of acute abdomen. Emergency exploratory laparotomy revealed a haemoperitoneum of 1500 mL and active bleeding from a 3×2 cm rupture in the right hemidiaphragm. Haemostasis was achieved and the patient recovered well post-operatively. This case highlights the importance of considering diaphragmatic rupture in the differential diagnosis of acute abdomen and haemorrhagic shock, especially in patients with ectopic pregnancy.