Gastrostomy as an Adjunctive Gastropexy in Recurrent Congenital Diaphragmatic Hernia with Repeated Gastric Herniation: A Case Report.
- 1Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
- 2Division of Neonatology, Center for Maternal and Infant Care, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan.
Abstract
Introduction
Although the survival of patients with congenital diaphragmatic hernia (CDH) has improved with advances in perinatal management, postoperative recurrence remains a significant complication. Risk factors for recurrence include large diaphragmatic defects, patch repair, liver herniation, and minimally invasive surgery. Recurrent CDH is associated with a high rate of subsequent recurrence, and the optimal surgical strategy has not been established. We report an infant with recurrent CDH and repeated gastric herniation who was treated with additional diaphragmatic reconstruction combined with gastrostomy fixation.Case presentation
A male infant with prenatally diagnosed left-sided CDH underwent primary repair on day 4 of life. A grade C defect with medial diaphragmatic deficiency was repaired using a cone-shaped GORE-TEX patch. At 4 months of age, follow-up imaging demonstrated recurrence with herniation of the stomach and colon into the left thoracic cavity. At reoperation, the lateral fixation of the patch remained intact, while its medial, anterior, and posterior portions had detached, and the patch had become displaced laterally. The defect was reconstructed using an additional patch. One week later, he developed a second recurrence accompanied by progressive intrathoracic gastric herniation with mesenteroaxial gastric volvulus, resulting in poor weight gain. At 5 months of age, a fourth operation revealed a similar pattern of patch detachment, with herniation of the stomach and colon. Additional patch reconstruction and gastrostomy fixation were performed. Postoperatively, the patient's oral intake and weight gain improved markedly, without gastrostomy-related complications. The gastrostomy button was removed at 1 year of age. At 18 months of age (13 months after the final operation and 6 months after gastrostomy removal), the patient demonstrated normal growth and development without recurrence.Conclusions
In this patient, the absence of reliable medial anchoring tissue, limitations of patch fixation, and repeated gastric migration may all have contributed to recurrent diaphragmatic reconstruction failures. Although the independent effect of gastrostomy fixation cannot be determined because it was performed concurrently with additional patch reconstruction, it may have helped limit gastric mobility as an adjunct to diaphragmatic re-reconstruction. This combined approach may be considered in selected patients with recurrent CDH, medial diaphragmatic deficiency, and repeated gastric herniation.
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BibTeX
@article{ishii2026gastrostomy,
title = {{Gastrostomy as an Adjunctive Gastropexy in Recurrent Congenital Diaphragmatic Hernia with Repeated Gastric Herniation: A Case Report.}},
author = {Minori Ishii and Saya Azuma and Yuka Kumata and Yuki Meya and Keita Motoki and Haru Matsumoto and Saki Sugeno and Satsuki Suda and Aiko Aoyama and Toshio Okamoto and Ken Nagaya and Hisayuki Miyagi},
journal = {Surgical case reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0493},
url = {https://europepmc.org/article/MED/42969004},
note = {CC BY},
}
RIS
TY - JOUR
TI - Gastrostomy as an Adjunctive Gastropexy in Recurrent Congenital Diaphragmatic Hernia with Repeated Gastric Herniation: A Case Report.
AU - Minori Ishii
AU - Saya Azuma
AU - Yuka Kumata
AU - Yuki Meya
AU - Keita Motoki
AU - Haru Matsumoto
AU - Saki Sugeno
AU - Satsuki Suda
AU - Aiko Aoyama
AU - Toshio Okamoto
AU - Ken Nagaya
AU - Hisayuki Miyagi
PY - 2026
DA - 2026/10/28
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0493
UR - https://europepmc.org/article/MED/42969004
AB - Introduction Although the survival of patients with congenital diaphragmatic hernia (CDH) has improved with advances in perinatal management, postoperative recurrence remains a significant complication. Risk factors for recurrence include large diaphragmatic defects, patch repair, liver herniation, and minimally invasive surgery. Recurrent CDH is associated with a high rate of subsequent recurrence, and the optimal surgical strategy has not been established. We report an infant with recurrent CDH and repeated gastric herniation who was treated with additional diaphragmatic reconstruction combined with gastrostomy fixation.Case presentation A male infant with prenatally diagnosed left-sided CDH underwent primary repair on day 4 of life. A grade C defect with medial diaphragmatic deficiency was repaired using a cone-shaped GORE-TEX patch. At 4 months of age, follow-up imaging demonstrated recurrence with herniation of the stomach and colon into the left thoracic cavity. At reoperation, the lateral fixation of the patch remained intact, while its medial, anterior, and posterior portions had detached, and the patch had become displaced laterally. The defect was reconstructed using an additional patch. One week later, he developed a second recurrence accompanied by progressive intrathoracic gastric herniation with mesenteroaxial gastric volvulus, resulting in poor weight gain. At 5 months of age, a fourth operation revealed a similar pattern of patch detachment, with herniation of the stomach and colon. Additional patch reconstruction and gastrostomy fixation were performed. Postoperatively, the patient's oral intake and weight gain improved markedly, without gastrostomy-related complications. The gastrostomy button was removed at 1 year of age. At 18 months of age (13 months after the final operation and 6 months after gastrostomy removal), the patient demonstrated normal growth and development without recurrence.Conclusions In this patient, the absence of reliable medial anchoring tissue, limitations of patch fixation, and repeated gastric migration may all have contributed to recurrent diaphragmatic reconstruction failures. Although the independent effect of gastrostomy fixation cannot be determined because it was performed concurrently with additional patch reconstruction, it may have helped limit gastric mobility as an adjunct to diaphragmatic re-reconstruction. This combined approach may be considered in selected patients with recurrent CDH, medial diaphragmatic deficiency, and repeated gastric herniation.
SN - 2198-7793
ER -