RE-EXPANSION PULMONARY EDEMA FOLLOWING REPAIR OF MISSED POST TRAUMATIC DIAPHRAGMATIC HERNIA A CASE REPORT AND REVIEW OF LITERATURES.

Abstract

Reexpansion pulmonary edema following repair of missed diaphragmatic hernia is very rare .Here reported is a case of bilateral reexpansion pulmonary edema occurring after reconstruction of left sided post traumatic diaphragmatic hernia. The patient was re intubated and ventilated later put on supplemental oxygen via a catheter through the endotracheal tube followed by extubation and non re breather face mask to compensate for hypoxemia. He was given intravenous diuretics and inotropic support. Forty-eight hours after the acute event, the patient recovered with minimal residual hypoxemia. Reexpansion pulmonary edema after repair of missed diaphragmatic hernia is a rare complication with a high mortality rate of up to 20%. It should be considered in cases of hypoxemia following any chest reexpansion procedure. The exact pathophysiology leading to this complication is not clear but it is believed to be permeability pulmonary edema as a result of pulmonary micro vascular damage. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to insertion of chest tubes. Treatment is supportive and emphasis should be given for preventive measures.