Abstract
The patient is a 0-day-old boy. He was diagnosed as having a right congenital diaphragmatic hernia (CDH) by fetal MRI, and was born after 38 weeks of gestation by scheduled Caesarean delivery. He was intubated immediately after birth and was under respirator control with gentle ventilation until his general condition stabilized. We performed radical operation using a GORE-TEX® sheet for patch repair on day 4. After the surgery, the patient showed decreased urine volume, and his blood pressure dropped. We also found that the levels of his liver enzymes increased markedly. On the second day after surgery, since we found a decrease in his portal blood flow in the right hepatic lobe, we performed emergency laparotomy. As intraoperative findings, we found an abnormal lobulation of the liver, which was not fixed to the abdominal wall and was wandering, and a 180° coronal torsion of a part of the right lobe was found. We released the torsion and confirmed the improvement of portal blood flow by echogram before we closed his abdomen. From this case, we reacknowledged that it is crucial to investigate the torsion of migrated organs during the radical operation of diaphragmatic hernia. This is the first report of liver torsion after radical operation of right CDH.
