Bilateral eventration of the diaphragm with perforated gastric volvulus inan adolescent

Bilateral congenital eventration of the diaphragm almost uniformly presents in infancy with respiratory compromise and is associated with a high morta lity rate. Delayed presentation of diaphragmatic eventration in older child ren and adults may be associated with acute gastric volvulus. Thus, any pat ient with abdominal pain, vomiting, or nonspecific gastrointestinal symptom s in association with abnormal diaphragmatic findings on chest x-ray should undergo further diagnostic workup with upper gastrointestinal series or co mputed tomography (CT) scan. Treatment of gastric volvulus requires immedia te surgical repair to prevent subsequent necrosis and perforation. The auth ors describe a case report of bilateral congenital diaphragmatic eventratio n complicated by a perforated gastric volvulus in a 13-year-old boy. Emerge nt reduction of the volvulus, closure of the perforated stomach, plication of the diaphragm, and placement of gastrostomy was performed successfully. J Pediatr Surg 35:1824-1826. Copyright (C) 2000 by W.B. Saunders Company.