Thoracic Occupation of All Abdominal Organs in a Neonate: Intraoperative Surprise of Diaphragmatic Eventration

Congenital Diaphragmatic Hernia (CDH) is commonly diagnosed at birth or in the early days of life. It is commonly observed on the left side, with a male predominance. It can be diagnosed during prenatal scans using common diagnostic modalities such as ultrasound. Diaphragmatic eventration is an abnormal elevation of the diaphragm caused by muscle paralysis, thinning, and/ or weakness without any disruption or continuity in the diaphragm. Severe congenital diaphragmatic eventration can mimic CDH and present a diagnostic challenge. Foetal Magnetic Resonance Imaging (MRI) can help differentiate congenital diaphragmatic eventration from CDH. This is a case of a nine-day-old male neonate, presented to the emergency department with respiratory distress, and was subjected to radiological investigations, which showed left-sided CDH, Bochdalek type. Intraoperatively, a large diaphragmatic eventration was found. The neonate underwent a successful Bochdalek congenital diaphragmatic repair and was discharged on postoperative day 30. A follow-up at 1.5 months showed the infant recovering well postoperatively with no new complications. This case highlights the imaging-operative discordance. This neonate with acute respiratory distress, imaging suggestive of Bochdalek CDH, and an intraoperative finding of extensive eventration (rather than a full‑thickness posterolateral defect) is rarely detailed. The successful management of this case was evident by an uneventful postoperative recovery.