Gastric volvulus post thoracoscopic congenital diaphragmatic hernia repair: a case report

Introduction Gastric volvulus is a rare but critical complication following thoracoscopic repair of congenital diaphragmatic hernia (CDH). This case revealed the risks associated with an intrathoracic stomach and the limitations of thoracoscopic visualization in development of gastric volvulus. Case presentation We report a term male infant born at 38+4 weeks of gestation with a birth weight of 3180g, who developed gastric volvulus immediately following the thoracoscopic repair of a left congenital diaphragmatic hernia (CDH) on day 5 of life. Preoperative imaging demonstrated herniation of the stomach and intestine into the thorax. Following successful thoracoscopic repair using a Gore-Tex patch, the patient developed persistently high-volume gastric aspirates. Radiography on postoperative day (POD) 3 revealed an abnormal gastric bubble, and a contrast study on POD 5 confirmed gastric volvulus. Diagnostic laparoscopy on POD 8 demonstrated an organoaxial volvulus. The volvulus was subsequently reduced, and an anterior gastropexy was performed by suturing the stomach to the abdominal wall. The patient tolerated feeds and was discharged uneventfully. At 3-year follow-up, he remained asymptomatic and complication-free. Conclusion The congenital laxity of the stomach in patients with left CDH may increase the risk of gastric volvulus at the time of CDH repair. This complication may not be visible when the CDH repair is done thoracoscopically and should be suspected in patients with high postoperative gastric output and an abnormal gastric bubble on plain films.