Abstract
INTRODUCTION: There have been two cases of congenital diaphragmatic hernia associated with a gastroesophageal duplication cyst documented in the literature, both presented symptomatically in the newborn period. This case is unique given the patient presented in adolescence asymptomatically. PRESENTATION OF CASE: We present a case of a 15-year-old female who initially presented with lower abdominal pain. A CT chest and abdomen was concerning for a moderate to large hiatal vs diaphragmatic hernia and an adjacent 4.3 cm lower mediastinal cyst. Though asymptomatic, the patient underwent diagnostic thoracoscopy with cyst excision. On post operative day one, the patient endorsed severe uncontrolled abdominal pain with multiple bouts of non-bilious emesis. Chest X-ray and upper GI were positive for herniation of the stomach through the diaphragm. The patient was taken back to the operating room emergently for diagnostic thoracoscopy where the stomach was found herniated through a diaphragmatic defect with no evidence of necrosis. The stomach was reduced into the abdominal cavity. The patient tolerated this procedure well, recovered appropriately and was seen two-weeks post-operatively fully recovered. DISCUSSION: Better visualization and thorough tactile check of the diaphragmatic defect during the initial operation would increase the chance of detecting a defect in the diaphragm immediately and avoid subsequent herniation of abdominal contents. CONCLUSION: When Foregut duplication cysts exist near the diaphragm it is critical to get a thorough view of the anatomy and ensure no diaphragmatic defect exits.