Acquired diaphragmatic hernia post-heart transplant with omentum pull-up in a child: a case report

Acquired diaphragmatic hernias are rare, yet serious complications. This report details the unique case of a 2-year-old female who developed a right-sided diaphragmatic hernia following an omentum pull-up procedure, which occurred after a heart transplant for dilated cardiomyopathy. We present the case of a 2-year-old female patient who suffered from dilated cardiomyopathy, necessitating a heart transplant in her first year of life. Subsequently, an omentum pull-up was performed to manage a sternum that had dehisced with an infectious focus. Following this, she was exclusively on nasogastric (NG) tube feeding due to recurrent gagging and vomiting. She then presented with acute signs of pneumonia, vomiting, and cough. A chest radiograph and computed tomography scan revealed intestinal loops in the right thoracic cavity, suggesting a diaphragmatic defect. Surgical repair through median laparotomy successfully reduced the herniated transverse colon and primarily closed the anterior diaphragmatic defect. Postoperatively, the patient's respiratory status improved. However, despite consultations with the dietetics team and two previous rehabilitation attempts for tube weaning, she has not yet transitioned to oral nutrition and remains dependent on the NG tube, with a gastrostomy pending. Children who develop respiratory symptoms after undergoing a heart transplant followed by an omental pull-up should have an acquired diaphragmatic hernia ruled out.