Emergency, anaesthetic and intensive care management of a case of eventration of diaphragm, Bochdalek hernia and an intra-thoracic gastric rupture with gastric gangrene

Abstract

A combination of eventration of diaphragm, Bochdalek hernia and an iatrogenic intra-thoracic gastric rupture with gastric gangrene is rare and poses various challenges which require urgent and efficient management with close co-ordination between various specialities. We describe a 23-year-old female admitted with a history of pain in abdomen, chest pain, breathlessness and profound circulatory shock. Our patient suffered an iatrogenic gastric perforation induced by inadvertent insertion of the intercostal drain. Successful management of this challenging patient required quick decision making, skilled peri- operative care, good communication and close cooperation between the Anaesthesiologist, General Surgeon, Cardiothoracic Surgeon and Radiologist.