Difficult diagnosis in the emergency department: Hyperemesis in early trimester pregnancy because of incarcerated maternal diaphragmatic hernia

Ting, Joseph Yuk Sang (2008) Difficult diagnosis in the emergency department: Hyperemesis in early trimester pregnancy because of incarcerated maternal diaphragmatic hernia. Emergency medicine Australasia, 20 5: 441-443. doi:10.1111/j.1742-6723.2008.01119.x


Author Ting, Joseph Yuk Sang
Title Difficult diagnosis in the emergency department: Hyperemesis in early trimester pregnancy because of incarcerated maternal diaphragmatic hernia
Journal name Emergency medicine Australasia   Check publisher's open access policy
ISSN 1442-2026
1742-6731
1742-6723
Publication date 2008-10
Sub-type Article (original research)
DOI 10.1111/j.1742-6723.2008.01119.x
Volume 20
Issue 5
Start page 441
End page 443
Total pages 3
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 110305 Emergency Medicine
11 Medical and Health Sciences
111402 Obstetrics and Gynaecology
Abstract Hyperemesis gravidarum is a frequent presentation to the ED, which usually resolves with fluid rehydration and antiemetics. Early incarcerated maternal diaphragmatic hernia might be misdiagnosed as relatively benign hyperemesis gravidarum in the first two trimesters of pregnancy. Diagnosis is missed because of non-specific presentation with abdominal pain, nausea and vomiting. Hernias rarely become symptomatic even in latter stages of pregnancy, as the uterus increases in size with each trimester and with raised intra-abdominal pressure from uterine contraction during labour. Symptoms progress with incarceration and strangulation of abdominal contents within the thoracic cavity, compression of the lung and disruption of caval venous return. A woman at 19-week gestation presented with delayed diagnosis of strangulated diaphragmatic hernia, representing the earliest gestation in the published literature when this has occurred. She had repeatedly been misdiagnosed with hyperemesis gravidarum. It is worthwhile considering incarcerated maternal diaphragmatic hernia as an unusual cause of refractory vomiting in pregnancy, when associated with clinically significant upper abdominal pain and progressive respiratory embarrassment. This might occur as early as the mid-second trimester, and without uterine contraction.
Keyword Diaphragmatic hernia
Gestation
Hyperemesis gravidarum
Incarceration
Mid-trimester
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article first published online: 14 October 2008

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 21 Dec 2009, 10:02:29 EST by Maria Campbell on behalf of Faculty Of Health Sciences