Undiagnosed maternal diaphragmatic hernia \u2013 a management dilemma

Maya Reddy,Annie Kroushev,Kirsten Palmer

doi:10.1186/s12884-018-1864-4

Maya Reddy, Annie Kroushev + Show 1 more

Open Access

https://doi.org/10.1186/s12884-018-1864-4

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Abstract

BackgroundMaternal 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.ConclusionMaternal diaphragmatic hernias in pregnancy require multidisciplinary care and individualised management in order to allow for the optimal outcome for mother and foetus.

Highlights

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
The majority of Congenital diaphragmatic hernias (CDH) are diagnosed antenatally and surgically repaired in the neonatal period. Those that are not diagnosed in utero often present with respiratory or intestinal symptoms in the first few years of life [2]. It is relatively uncommon for diaphragmatic hernias to be diagnosed in adulthood [3]
First presentation in pregnancy is scarcely described in the literature and the management largely involves immediate surgical repair

Summary

Introduction

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. Delivery by caesarean section occurred following concerns of malnutrition and partial bowel obstruction This was followed by immediate surgical repair of the hernia. The majority of CDH are diagnosed antenatally and surgically repaired in the neonatal period Those that are not diagnosed in utero often present with respiratory or intestinal symptoms in the first few years of life [2]. It is relatively uncommon for diaphragmatic hernias to be diagnosed in adulthood [3]. We describe a rare case of an undiagnosed maternal CDH manifesting late in pregnancy. In this scenario, we explore the possibility of expectant management and the potential multidisciplinary challenges that may arise from this approach

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