Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report

Abstract

Background: The occurrence of a diaphragmatic hernia during the third trimester of pregnancy is rare; to our knowledge, there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy. Nonspecific symptoms and lack of experience due to its rarity make the diagnosis of this condition very challenging. We report a case of diaphragmatic hernia accompanied by mild acute pancreatitis in the third trimester of pregnancy, which was misdiagnosed as severe acute pancreatitis.

Case summary: A 19-year-old woman presented at gestation of 31⁺² weeks with continuous distension pain for 3 d in the left lumbar region of no obvious cause. Ultrasonographic findings of left ureterectasis, with nonspecific lumbago and abdominal pain, led to the misdiagnosis of renal colic. Increased serum amylase and/or lipase levels indicated acute pancreatitis. Following the treatment of pancreatitis, her condition deteriorated. The patient was finally diagnosed with a diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital. Caesarean section was performed at gestation of 31⁺⁶ weeks, followed by hernia repair, and the pancreatitis was treated sequentially. The patient was discharged in good condition 20 d after the surgery.

Conclusion: In this case, surgical treatment was not the same as that for non-pregnant diaphragmatic hernia repair. It is important to first perform a cesarean section before commencing the therapy.

Keywords: Acute pancreatitis; Case report; Diagnosis; Diaphragmatic hernia; Pregnancy; Therapy.

Figure 1

Magnetic resonance imaging findings. A: Foetus in pregnancy; B: Diaphragmatic hernia; C: Pancreatitis; D: The position of the abdominal organs and tissues was changed.