Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4660-4666
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4660
Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report
Yun-Zhi Zou, Jin-Pu Yang, Xiao-Jiang Zhou, Ke Li, Xiao-Mei Li, Cong-Hua Song
Yun-Zhi Zou, Ke Li, Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
Jin-Pu Yang, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Xiao-Jiang Zhou, Ke Li, Cong-Hua Song, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Xiao-Mei Li, Clinical Research Center, Xiamen University, Xiamen 361102, Fujian Province, China
Author contributions: Song CH and Li XM designed this research; Zou YZ wrote the first draft, revised it, and completed the final manuscript; Yang JP wrote first draft; Zhou XJ and Li K provided related information; all authors approved the final version.
Supported by the National Natural Science Foundation of China, No. 81860099.
Informed consent statement: All of the study participants or their legal guardians provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study.
CARE Checklist (2016) statement: Guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cong-Hua Song, MD, PhD, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. kesongs@email.ncu.edu.cn
Received: July 31, 2020
Peer-review started: July 29, 2020
First decision: August 7, 2020
Revised: August 12, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: October 6, 2020
Processing time: 58 Days and 10.5 Hours
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: Diaphragmatic hernia; Pregnancy; Acute pancreatitis; Diagnosis; Therapy; Case report

Core Tip: Pregnancy with acute pancreatitis is rare, and pregnancy with diaphragmatic hernia is even rarer. To our knowledge, there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy. We here report a case of a 19-year-old woman in the third trimester of pregnancy presenting with continuous distension pain for 3 d in the left lumbar region, who was misdiagnosed with severe pancreatitis. She was finally diagnosed with diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital. The patient underwent caesarean section followed by hernia repair and was subsequently treated for pancreatitis. The patient's condition progressively improved 15 d after the surgery, and the patient was discharged in good condition 20 d after the surgery.