Complicated diaphragmatic hernia post laparoscopic Nissen fundoplication: a case report.

BACKGROUND

The definition of gastroesophageal reflux disease is gastroesophageal reflux with associated symptoms or complications. Because parents or guardians perceive the disease's symptoms differently, it is difficult to determine how common it is. Although gastric volvulus and wrap migration are well-known complications following Nissen fundoplication, the herniation in our case was caused by a defect medial to the hiatus, which could potentially compromise the patient's life in the future.

CASE PRESENTATION: We present a rare complication post laparoscopic Nissen fundoplication, four years male Egyptian child presented to emergency department by shock, rigid abdomen. X-ray and CT scan abdomen showed herniated stomach with ischemic volvulus of the stomach and pneumoperitoneum, exploration was done and case managed successfully.

CONCLUSION

Gastric volvulus is a complication with high morbidity and mortality outcomes that could be missed or misdiagnosed, especially post laparoscopic fundoplication, high index of suspicion is the key to detect such complications. Defects in diaphragm could be present in pediatric patients because of congenital or acquired causes, careful inspection of diaphragm during laparoscopic fundoplication is an important step to detect possible defects to minimize post operative complications.