Laparoscopic mesh repair of a Bochdalek diaphragmatic hernia with acute gastric volvulus in a pregnant patient

Palanivelu C, Rangarajan M, Maheshkumaar GS, Parthasarathi R
Correspondence: Prof M Rangarajan, angy68@gmail.com

ABSTRACT
The advantages of minimally invasive therapy can be utilised in the surgical disorders of pregnant patients. To our knowledge, there has not been a previous report describing laparoscopic management of diaphragmatic hernia (with mesh) in pregnancy. A 23-year-old pregnant (second trimester) woman was admitted with vomiting, epigastric pain, oliguria and dyspnoea of one month duration. Investigations revealed posterolateral diaphragmatic hernia of Bochdalek with gastric volvulus. Successful laparoscopic mesh-plasty of the diaphragmatic hernia was performed without mortality or morbidity to both mother and child. Principles of laparoscopic surgery for diaphragmatic hernias remain the same. Pregnancy poses challenges to both surgeon and anaesthetist due to changes in the physiology. Acute diseases that threaten the life of mother and child have to be dealt with urgently. We conclude that even complex laparoscopic surgery during pregnancy is feasible.

Keywords: diaphragmatic hernia, gastric volvulus, laparoscopic surgery, pregnancy
Singapore Med J 2008; 49:e26-8.