scholarly journals Laparoscopic approach for diaphragmatic hernia repair in adult: our experience of four cases

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Abhijeet Kumar ◽  
Ratish Karn ◽  
Bhawani Khanal ◽  
Suresh Prasad Sah ◽  
Rakesh Gupta
Keyword(s):  
Diaphragmatic Hernia ◽  
Clinical Presentation ◽  
Clinical Investigation ◽  
Gastrointestinal Symptoms ◽  
Laparoscopic Approach ◽  
X Ray ◽  
Patch Closure ◽  
Thoracic Approach ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory/gastrointestinal symptoms and occasionally atypical presentation as lumbar hernia also. The diagnosis of diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray film and computed tomography scan. Various treatment approaches, open, laparoscopic and combination, are available for this condition. However, laparoscopic approach has recently gained in popularity. Surgical repair typically involves primary or patch closure of the diaphragm through an open or endoscopic abdominal or thoracic approach. This paper reflects our experience of repair of diaphragmatic hernias to evaluate its safety, efficacy and outcomes.

scholarly journals Faecopneumothorax due to missing diaphragmatic hernia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Resul Nusretoğlu ◽  
Yunus Dönder
Keyword(s):  
Computed Tomography ◽  
Diaphragmatic Hernia ◽  
Colon Resection ◽  
Emergency Laparotomy ◽  
Hernia Sac ◽  
Case Presentation ◽  
Abdominal Tenderness ◽  
History Of ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

scholarly journals Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Jennifer M. Kim ◽  
Marisa Couluris ◽  
Bruce M. Schnapf
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Gastrointestinal Symptoms ◽  
Lower Lobe ◽  
Abdominal Radiograph ◽  
Rare Occurrence ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
Diaphragmatic Hernias ◽  
Vague Abdominal Pain

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence.

Anterior diaphragmatic hernias in children: long-term surgical outcomes

2021 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
D.A. Morozov ◽  
◽  
D.V. Khaspekov ◽  
E.A. Okulov ◽  
V.G. Masevkin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diaphragmatic Hernia ◽  
Complex Analysis ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
X Ray ◽  
Hernial Sac ◽  
Chest X Ray ◽  
Diaphragmatic Hernias

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia

scholarly journals "Stray" achalasia: From gastroenterologist to pulmonologist and back

2016 ◽  
Vol 144 (1-2) ◽  
pp. 85-89
Author(s):  
Dusanka Obradovic ◽  
Biljana Joves-Sevic ◽  
Milos Stojanovic ◽  
Miroslav Ilic ◽  
Igor Ivanov
Keyword(s):  
Correct Diagnosis ◽  
Gastrointestinal Symptoms ◽  
Computed Tomography Scan ◽  
X Ray ◽  
Chest X Ray ◽  
Pulmonary Infiltration ◽  
Fluid Levels ◽  
Tomography Scan ◽  
Frequent Presence

Introduction. Achalasia is a rare esophageal disorder which, due to frequent presence of both respiratory and gastrointestinal symptoms, can initially be referred either to pulmonologist or gastroenterologist. Case Outline. A 50-year-old patient was initially referred to gastroenterologist with the following symptoms: nausea, vomiting, occasional hiccups, weight loss, chest pain, dysphonia, and dry cough. After chest X-ray, the patient was referred to pulmonologist with differential diagnosis for pulmonary infiltration and thoracic aortic aneurysm. Pulmonologist interpreted chest X-ray as showing paratracheal mediastinal enlargement with air-fluid levels, thus suspecting achalasia. Computed tomography scan of the thorax with per os contrast showed extremely dilated esophagus with food stasis. The patient was then referred to thoracic surgeon, who ordered additional diagnostics (esophageal passage with contrast, esophagomanometry, esophagogastroduodenoscopy), and finally performed Heller myotomy. Postoperatively there were no complications, and the patient was symptom free during the follow-up. Conclusion. Although achalasia can also result in respiratory symptoms, fastidious anamnesis and accurate radiological interpretation are essential for the correct diagnosis.

scholarly journals An Atypical Presentation of a Strangulated Bochdalek Hernia in a 60-Year-Old Man

2019 ◽  
Vol 7 (11) ◽  
pp. 1818-1820
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Abdominal Pain ◽  
Congenital Diaphragmatic Hernia ◽  
Male Patient ◽  
Diaphragmatic Hernia ◽  
Laparoscopic Approach ◽  
Atypical Presentation ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Diaphragmatic Hernias

BACKGROUND: Bochdalek hernia is a type of congenital diaphragmatic hernia (CDH), which more commonly affects children. Congenital left diaphragmatic hernias, such as Bochdalek, rarely occur in adults. Most such cases do not present any symptoms. CASE PRESENTATION: Here, we report the case of a 60-year-old male with a left-sided Bochdalek diaphragmatic hernia, who presented with abdominal pain and dyspnea. The patient was successfully treated by laparoscopic approach.CONCLUSION: The 60-year-old male patient had left-sided BH and was successfully cured by the laparoscopic approach.

scholarly journals Tension Viscerothorax in a Patient with Missed Traumatic Diaphragmatic Hernia. A Case Report.

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Herbert Butana ◽  
Ntawunga Laurance ◽  
Desire Rubanguka ◽  
Isaie Sibomana
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Diaphragmatic Hernia ◽  
Rare Case ◽  
Case Presentation ◽  
X Ray ◽  
Traumatic Diaphragmatic Hernia ◽  
Provincial Hospital ◽  
Chest X Ray ◽  
Diaphragmatic Hernias

Background: Diaphragmatic hernias occurring post trauma are a challenge to diagnose early especially when they follow blunt trauma. Many of those diagnosed early occur in penetrating thoraco-abdominal trauma which necessitates emergency exploration where the diagnosis is picked. Rarity of traumatic diaphragmatic hernia coupled with poor sensitivity of easily available imaging modalities makes it a big challenge to pick up this potentially fatal pathology. Case presentation: We present a rare case of tension viscerothorax in a young man who had presented to the emergency department at a provincial hospital of Rwanda three days before the second consultation where the chest x-ray was interpreted as normal and later as a pneumothorax before the diagnosis and treatment of tension viscerothorax could be made. Conclusion: Viscerothorax is an elusive diagnosis which when missed can complicate to strangulation of hernia contents or tension viscerothorax which carry a high mortality.

scholarly journals Congenital Diaphragmatic Hernia with Intrathoracic Renal Ectopia: Thoracoscopic Approach for a Complete Anatomical Repair

2020 ◽  
Vol 08 (01) ◽  
pp. e74-e76
Author(s):  
Colin Mizzi ◽  
David Farrugia ◽  
Muhammad S. Choudhry
Keyword(s):  
Adrenal Gland ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Left Kidney ◽  
Computed Tomography Scan ◽  
Baby Girl ◽  
Thoracoscopic Approach ◽  
X Ray ◽  
Chest X Ray ◽  
Tomography Scan

AbstractCongenital diaphragmatic herniae (CDH) with associated intrathoracic ectopic kidneys are rare congenital anomalies, with a reported incidence of only 0.25%. The authors report a case of a 24-day-old baby girl who was diagnosed with a left-sided CDH on a chest X-ray taken for pneumonia. Computed tomography scan showed CDH hernia, containing small and large bowel and whole left kidney with adrenal gland. Thoracoscopic reduction in the bowel, kidney, and adrenal gland into the abdomen and primary closure of the defect was achieved with no complications. During investigation of the child, it was discovered that her maternal aunt had also had a left-sided congenital diaphragmatic hernia containing the kidney, which was treated via open surgery after birth; she subsequently developed renal cell carcinoma and required radical nephrectomy of that kidney during her third decade.

Effects of X-Ray Exposure on Some CMI Regulatory Cytokines in Technicians Serum Samples

2018 ◽  
Vol 9 (4) ◽  
Author(s):  
Weam S Al-Hamadany
Keyword(s):  
Clinical Status ◽  
Cell Mediated Immunity ◽  
Normal Range ◽  
Serum Samples ◽  
X Ray ◽  
Immunosuppressive Factor ◽  
Elisa Technique ◽  
Immunological Process ◽  
Field Workers ◽  
Tomography Scan

Ionizing radiation considered as an immunosuppressive factor upon over dose of exposure. Radiation field workers usually following a periodic checkup to monitor changes in their clinical status. Cell Mediated Immunity (CMI) has an important cytokines that regulate this specific immunological process. This study estimated the Interleukins (IL-2, IL-12 and IL-18) levels in serum samples using ELISA technique. Serum samples were collected from X-ray Technicians (Radiography, Fluoroscopy and Computed Tomography Scan Technicians) working in AL-Muthanna governorate hospitals. A total of (60) technicians and (30) control were involved in this research. Results showed significant decrease in IL-2 levels and increase in IL-18 levels in test groups (technicians) as compared with controls. While, IL-12 levels did not show a difference; all obtained values were within normal range. Overdose of X-ray exposure caused CMI suppression via disturbing the levels of critical cytokines (IL-2 and IL-18) leading to CMI loss regulation.

Hérnia Diafragmática Congênita: Relato de Caso/ Congenital Diaphragmatic Hernia: Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 27-34
Author(s):  
Lucas Tavares Dos Santos ◽  
Tânia Massini Evangelista
Keyword(s):  
Case Report ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Esophageal Hiatus ◽  
Bochdalek Hernia ◽  
Severe Respiratory Distress ◽  
X Ray ◽  
Venous Catheterization ◽  
Terapia Intensiva

Introdução: A hérnia diafragmática congênita é a falha do fechamento embrionário do músculo diafragmático, resultando em um defeito de continuidade. Esta patologia pode ocorrer pela passagem de estruturas do abdome através de um defeito no diafragma, ou haver herniação parcial do estômago através do hiato esofágico, paralisia frênica com deslocamento do conteúdo abdominal para cima, mas sem herniação, e, eventração do diafragma. Casuística: Foi relatado um caso de hérnia diafragmática congênita, hérnia de Bochdalek, em um recém – nascido do sexo feminino, que nos ultra-sonografias da gestante apresentavam sem alterações. O diagnóstico da patologia foi feito apenas após a realização de raios-X de tórax e abdome para confirmar a posição do cateterismo umbilical venoso. Discussão/Conclusão: A apresentação clínica da hérnia de diafragmática congênita inclui desconforto respiratório moderado a grave com repercussão sistêmica. O diagnóstico, em cerca de 80% dos casos, é feito por ultrassom pré-natal. O tratamento proposto foi intubação endotraqueal com ventilação mecânica e programação para correção cirúrgica da hérnia. Após correção cirúrgica da patologia, a paciente permaneceu na unidade de terapia intensiva neonatal por 21 dias para acompanhamento de pós – operatório e intercorrências na evolução. Palavras-chave: hérnia diafragmática congênita, recém-nascido, hérnia de BochdalekABSTRACTIntroduction: Congenital diaphragmatic hernia is the failure of embryonic closure of the diaphragm, resulting in a lack of continuity. This condition can occur by passing structures of the abdomen through a defect in the diaphragm, or be part herniation of the stomach through the esophageal hiatus, phrenic paralysis with displacement of abdominal contents up but no herniation, and eventration of the diaphragm. Case Report: We report a case congenital diaphragmatic hernia, such as Bochdalek hernia, in a new - born female that in ultrasounds of pregnant women showed without change. The diagnosis of the disease was made only after conducting X-ray of the chest and abdomen to confirm the position of umbilical venous catheterization. Discussion/Conclusion: Clinical presentation of congenital diaphragmatic hernia includes moderate to severe respiratory distress with systemic repercussions. The diagnosis in about 80% of the cases is done by ultrasound prenatally. The proposed treatment was endotracheal intubation with mechanical ventilation and programming for surgical correction of the hernia. After surgical pathology, the patient remained in neonatal intensive care unit for 21 days to monitor post - operative complications and evolution.  Keywords: congenital diaphragmatic hernia, newborn, Bochdalek hernia 

scholarly journals An Unusual Cause of Pulmonary Nodules in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Ryan Yu ◽  
Melanie Ferri
Keyword(s):  
Emergency Department ◽  
Smooth Muscle ◽  
Clinical Presentation ◽  
Pulmonary Nodules ◽  
Pleuritic Chest Pain ◽  
Benign Metastasizing Leiomyoma ◽  
Spindle Cells ◽  
Smooth Muscle Tumors ◽  
Metastasizing Leiomyoma ◽  
Tomography Scan

We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

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