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Tangled Within : A rare presentation of splenic and gastric volvulus in CDH
Meryem Unal, Kuhaendran A/L Gunaseelan, Yvonne Leong, Hazlina Mohd Khalid, Mughni Bahari
Sabah Woman and Children Hospital (SWACH)
Introduction:
Congenital diaphgramatic hernia (CDH), typically presents in the neonatal period, with an incidence of 1 in 2,000 - 5000 live births. We present an unusual case of CDH which presented later and was complicated by splenic and gastric volvulus.
Case Presentation:
We present the case of a 12-year-old girl with a 1-day history of acute epigastric pain on a background of intermittent abdominal pain over the past year. Examination revealed abdominal tenderness with bilious drainage from a nasogastric tube. Chest radiograph showed the tube coiled in the left hemithorax with bowel shadows, while CT imaging revealed a left-sided diaphragmatic defect with herniation of the stomach, small bowel, and colon, along with a pelvic wandering spleen with features of infarction and vascular torsion.
She underwent an emergency laparotomy, which revealed a posterolateral CDH without sac, containing the stomach, entire small bowel, and colon up to the transverse segment. The stomach was dilated with mesenteroaxial volvulus, and the spleen was torsed 1080°, infarcted, and located in the pelvis. Surgical procedures included CDH repair, splenectomy, gastropexy, and ascending colopexy. She was extubated on postoperative day 2 and recovered uneventfully.
Conclusion:
This case highlights the importance of maintaining a high index of suspicion for wandering spleen and gastric volvulus in children presenting with abdominal pain, particularly in the presence of CDH. Early imaging and timely surgical intervention are key to favorable outcomes.