Lesson Learned From an In Situ Tube Thoracostomy in Postoperative Congenital Diaphragmatic Hernia Repair: Even an Open Pneumothorax Can Be Catastrophic

Abstract

Over the last few decades, the perioperative management of congenital diaphragmatic hernia (CDH) has improved, yet, the management is challenging. Complications are common, and pleural complications like pneumothorax and effusion after open CDH repair are still a concern. Tube thoracostomy is often inserted to reduce postoperative pleural complications. However, tube thoracostomy, although having benefits and thought to be innocuous, may lead to life-threatening complications like tension pneumothorax. The present case report highlights an unusual scenario of acute respiratory failure with near cardiac arrest in the immediate postoperative period where the cause of the catastrophe was open pneumothorax rather than the tension one. The possible phenomena behind the said cause are described.

Keywords

• congenital diaphragmatic hernia
• pneumothorax
• cardiac arrest
• patient safety