“What Goes Up Must Come Down”: Laparoscopic Retrieval of a Migrated Intrathoracic Kidney and Repair of Recurrent Symptomatic Diaphragmatic Hernia

Background: Congenital diaphragmatic hernia is a rare condition describing a developmental defect of the diaphragm. It is managed surgically in the neonatal period by reduction of the herniated viscera followed by repair of the defect. We present a laparoscopic repair of a Bochdalek diaphragmatic hernia recurrence with retrieval and nephropexy of a migrated kidney with reduced function from its ectopic thoracic position. The complexities of managing this rare occurrence and lessons from this surgical challenge are discussed. Case Presentation: A 21-year-old primigravida presented with a 3-day history of right upper quadrant pain and increasing dyspnea. Of note, she had undergone a congenital right-sided diaphragmatic hernia repair as an infant. An MRI revealed a recurrent diaphragmatic defect with ectopic migration of the right kidney and bowel into an intrathoracic position. Due to worsening dyspnea, she underwent prompt laparoscopic repair of her recurrent diaphragmatic hernia. Subsequently, she underwent a planned cesarean section to control her intra-abdominal pressures and reduce the risk of hernia repair failure. Conclusion: Raised intra-abdominal pressures during pregnancy in patients with prior congenital hernia repair can result in recurrence and migration of peritoneal and retroperitoneal contents into the chest. In cases of renal unit migration, the primary concern must be to restore the anatomical position of a functioning kidney. Multidisciplinary specialist involvement in a tertiary referral base is crucial to an effective outcome.