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

## TL;DR

A rare case of a life-threatening diaphragmatic hernia following a laparoscopic Nissen fundoplication in a child is reported, highlighting the importance of careful surgical inspection.

## Contribution

This case report highlights a rare and potentially life-threatening complication of laparoscopic Nissen fundoplication in pediatric patients.

## Key findings

- A four-year-old child developed a diaphragmatic hernia with ischemic gastric volvulus after laparoscopic Nissen fundoplication.
- Careful inspection of the diaphragm during surgery is crucial to detect defects and prevent future complications.
- High clinical suspicion is needed to diagnose such rare post-operative complications in children.

## Abstract

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.

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.

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.