# Emergent Bedside Thoracotomy for Decompression of an Incarcerated Neonatal Bochdalek Hernia: A Case Report

## TL;DR

A newborn with a severe diaphragm defect had life-saving emergency surgery to relieve chest pressure and restore heart function.

## Contribution

This case report introduces emergent bedside thoracotomy as a novel life-saving intervention for critical neonatal diaphragmatic hernias.

## Key findings

- Emergency thoracotomy during CPR restored spontaneous circulation in a neonate with a Bochdalek hernia.
- Surgical repair and temporary abdominal closure led to successful recovery without complications.
- The case emphasizes the importance of rapid decompression in neonatal diaphragmatic hernia emergencies.

## Abstract

Congenital diaphragmatic hernia (CDH) is a rare and potentially life‐threatening condition caused by incomplete diaphragm formation, allowing abdominal organs to herniate into the thoracic cavity. This typically results in pulmonary hypoplasia and, rarely, cardiac compression with subsequent cardiopulmonary collapse. We report the emergency management of a three‐week‐old term neonate with a previously undiagnosed left‐sided Bochdalek hernia who presented at an external hospital with cardiac arrest and mediastinal shift due to massive obstructing enterothorax. Following stabilization and transfer to our hospital, a second cardiac arrest occurred in our neonatal intensive care unit (NICU). During cardiopulmonary resuscitation (CPR), an emergent bedside thoracotomy was performed, decompressing the thoracic cavity by exposing incarcerated bowel to the atmosphere, which led to the return of spontaneous circulation. Subsequent laparotomy revealed a small left‐sided diaphragmatic defect with incarcerated bowel. CDH repair and temporary abdominal wall closure using a silo patch were performed. Secondary closure was achieved 5 days later. The patient was discharged without complications. This case highlights emergent bedside thoracotomy as a life‐saving intervention in critical neonatal CDH.