Gastric volvulus in a neonate with congenital diaphragmatic hernia: A case report

Introduction: Gastric volvulus in neonates with congenital diaphragmatic hernia (CDH) is rare and typically presents beyond the neonatal period. Early neonatal presentation poses diagnostic and management challenges. Case presentation: A term (41-week) male neonate (3.6 kg) with an unremarkable prenatal course and normal prenatal ultrasound was born via vacuum-assisted vaginal delivery. Apgar scores were 0, 3, and 5 at 1, 5, and 10 minutes. He developed respiratory distress and worsening metabolic acidosis, requiring intubation. Chest radiograph showed a left-sided CDH with a large gastric bubble despite Replogle placement, raising concern for gastric volvulus. Due to progressive instability, he was transferred to our quaternary center and taken urgently to the operating room. Intraoperatively, a large left-sided diaphragmatic defect (2.5 x 3 cm) was identified with herniation and volvulus of the stomach, along with herniation of the small intestine, colon, and spleen. The stomach was detorsed, and the defect was repaired with a patch. His postoperative course was uneventful; feeds were initiated on postoperative day (POD) 5, and he was discharged home on full feeds on POD 33. At his 6-week follow-up, he remained asymptomatic with no recurrence. Conclusion: While gastric volvulus in patients with CDH is rare and typically presents beyond the neonatal period, it can also occur in neonates. Awareness of this early presentation can prompt timely surgical intervention and favorable outcomes.