A case of a strangulated diaphragmatic hernia

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.

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Obstructed descending colon mass pretended with Bockdalek hernia: a case report

10.21203/rs.3.rs-369079/v1 ◽

2021 ◽

Author(s):

mohammad eslamian ◽

Mohsen kolahdouzan

Keyword(s):

Diaphragmatic Hernia ◽

Abdominal Pressure ◽

Right Colon ◽

Abdominal Ct ◽

Midline Laparotomy ◽

Abdominal Ct Scan ◽

Descending Colon ◽

The Right ◽

Thoracic And Abdominal ◽

Diaphragmatic Hernias

Abstract Introduction: Adult Bochdalek hernia is one of the right-sided diaphragmatic hernias that less than 30 cases reported until now.Case: I herein report a 64-year-old female patient who had dyspnea, abdominal pain, and nausea. Primary imaging (thoracic and abdominal CT scan) showed a right-sided diaphragmatic hernia that was contained the liver and right colon. The patient underwent right posterior thoracotomy at first, so the 5*5 cm diaphragmatic defect was repaired. Due to peritonitis that happened after two days, a midline laparotomy was performed. Finally, it was cleared that the main problem was the obstructed and perforated descending colon mass that was presented with Bockdalek hernia. Unfortunately, she died.Conclusion It is important to determine the reason for the presentation of the symptomatic diaphragmatic hernia in adult patients. It should be considered that an increase of intra-abdominal pressure like the presence of obstructed colon mass can cause it.

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

ISRN Pulmonology ◽

10.5402/2011/409252 ◽

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.

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Anterior diaphragmatic hernias in children: long-term surgical outcomes

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2021-3-7-15 ◽

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

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Delayed Presentation of Traumatic Right-Sided Diaphragmatic Hernia after Abdominoplasty

Case Reports in Surgery ◽

10.1155/2014/949531 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Caroline C. Jadlowiec ◽

Lois U. Sakorafas

Keyword(s):

Diaphragmatic Hernia ◽

Normal Pressure ◽

Positive Pressure ◽

Delayed Presentation ◽

Pressure Gradients ◽

Abrupt Changes ◽

Thoracic And Abdominal ◽

Pressure Changes ◽

Surgical Manipulation ◽

Diaphragmatic Hernias

Traumatic diaphragmatic hernias are rare and challenging to diagnose. Following trauma, diagnosis may occur immediately or in a delayed fashion. It is believed that left traumatic diaphragmatic hernias are more common as a result of the protective right-sided anatomic lie of the liver. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as a result of the normal pressure changes observed between the thoracic and abdominal cavities. Additionally, abrupt changes to the pressure gradients, such as those which occur with positive pressure ventilation or surgical manipulation of the abdominal wall, can act as a nidus for making an asymptomatic hernia symptomatic. We report our experience with a delayed traumatic right-sided diaphragmatic hernia presenting with large bowel incarceration two months after abdominoplasty. In our review of the literature, we were unable to find any reports of delayed presentation of a traumatic right-sided diaphragmatic hernia occurring acutely following abdominoplasty.

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

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa178 ◽

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.

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Chronic Traumatic and Congenital Diaphragmatic Hernias: Presentation and Surgical Management

Canadian Respiratory Journal ◽

10.1155/2002/625025 ◽

2002 ◽

Vol 9 (2) ◽

pp. 135-139 ◽

Cited By ~ 8

Author(s):

Scott Sattler ◽

Timothy G Canty ◽

Michael S Mulligan ◽

Douglas E Wood ◽

J Michael Scully ◽

...

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Diaphragmatic Hernia ◽

Patch Repair ◽

Congenital Defects ◽

Radiographic Findings ◽

Chest Computed Tomography ◽

Marked Elevation ◽

Barium Studies ◽

Diaphragmatic Hernias

BACKGROUND: The diagnosis of chronic diaphragmatic hernias, whether due to congenital defects or trauma, may be difficult to make and may rely on clinical suspicion in the setting of persistent nondiagnostic radiographic findings. Repair is indicated to avoid catastrophic cardiopulmonary compromise and/or incarceration of abdominal organs.STUDY OBJECTIVES: To review the varied presentations and treatment of chronic diaphragmatic hernia.DESIGN: Retrospective review.SETTING: University of Washington and Harborview Medical Center, Seattle, Washington.PATIENTS: Between 1997 and 2001, nine patients presented with chronic diaphragmatic hernia (two congenital cases, seven post-traumatic cases). Four cases involved the right diaphragm. The following clinical features were noted: asymptomatic, chest radiograph showing bowel herniation (n=1); chest wall mass (n=1); asymptomatic with the chest radiograph showing marked elevation of hemidiaphragm (n=1); dyspnea with the chest radiograph showing marked elevation of hemidiaphragm (n=1); diarrhea and heartburn (n=1); generalized gastrointestinal upset (n=1); recurrent pneumonia (n=2); recurring effusions (n=4); and dyspnea on exertion (n=5).INTERVENTIONS: Diagnosis was confirmed by chest radiograph in two patients, chest computed tomography scan in one patient, barium studies in three patients and thoracoscopy in three patients. All hernias were repaired via thoracotomy, and two hernias were repaired with artificial patch.CONCLUSIONS: Patients with chronic diaphragmatic hernias present with a variety of symptoms and radiographic findings. When radiology or symptoms suggest bowel involvement, barium studies are appropriate. In other cases, chest computed tomography scans and/or thoracoscopy are useful. Repair is accomplished through the ipsilateral chest, with primary repair of the diaphragm preferred over patch repair.

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Laparoscopic Concomitant Sleeve Gastrectomy and Repair of a Morgagni Larrey Hernia - Case Report

Medical Image Database ◽

10.33695/mid.v2i1.25 ◽

2019 ◽

Vol 2 (1) ◽

pp. 11-12

Author(s):

IULIAN SLAVU ◽

Alecu Lucian ◽

Tulin Adrian

Keyword(s):

Sleeve Gastrectomy ◽

Diaphragmatic Hernia ◽

Postoperative Morbidity ◽

Surgical Intervention ◽

Intestinal Bleeding ◽

Morgagni Hernia ◽

Hernia Sac ◽

Left Hemidiaphragm ◽

Giovanni Battista Morgagni ◽

Diaphragmatic Hernias

Anterior diaphragmatic hernias are very rare surgical entities, scarce in symptoms, which occur through openings of the costal and sternal fascicules of the diaphragm. First described by Giovanni Battista Morgagni, in 1769, they are known under many names: Morgagni, Morgagni-Larrey. These hernias can develop in the left hemidiaphragm, right hemidiaphragm or bilateral. The preferred treatment when available is the laparoscopic suture of the defect. We present the case of a 52 years old female patient, with morbid obesity (BMI = 44.10 kg/m²) and Morgagni hernia. Other associated pathologies of the patient were high blood pressure, autoimmune thyroiditis, and sleep apneea. The initial diagnosis of diaphragmatic hernia was made a year earlier at a CT investigation. Laparoscopic sleeve gastrectomy and suture of the diaphragmatic defect were achieved without incidents during one single surgical intervention. A drainage tube was placed in the remaining cavity of the hernia. The hernia sac was conserved and used to reinforce the defect. The concurrent suture of the diaphragmatic hernia and sleeve gastrectomy do not increase the postoperative morbidity. The recovery was uneventful, thus the patient was spared a second surgical intervention . If present, these hernias are quickly identified due to the fact that laparoscopy allows a through exploration of the diaphragm. When diagnosed these defects should be repaired by suture due to the fact that they can cause life threating complications to the patient such as intestinal obstruction or gastro-intestinal bleeding if elements of the digestive tract are incarcerated in the defect.

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Congenital Diaphragmatic Hernia: Review of Current Concept in Surgical Management

ISRN Surgery ◽

10.5402/2011/974041 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 25

Author(s):

Emeka B. Kesieme ◽

Chinenye N. Kesieme

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Surgical Management ◽

Diaphragmatic Hernia ◽

Minimal Invasive Surgery ◽

Pulmonary Hypoplasia ◽

Open Repair ◽

Minimal Invasive ◽

Fetal Intervention ◽

Prosthetic Devices ◽

Diaphragmatic Hernias

Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.

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Right-sided congenital diaphragmatic hernia – the experience of the neonatal surgery center

Paediatric Surgery Ukraine ◽

10.15574/ps.2020.69.13 ◽

2020 ◽

pp. 13-23

Author(s):

O. Sliеpov ◽

◽

O. Ponomarenko ◽

M. Migur ◽

L. Sliеpova ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Low Frequency ◽

State Institution ◽

Medical Sciences ◽

Results Of Treatment ◽

The Difference ◽

Surgery Center ◽

Diaphragmatic Hernias

Congenital right-sided diaphragmatic hernias are a special form of diaphragmatic hernias. A relatively low frequency and features of anatomy, diagnosis clinical course, and survival characterize them. Objective: to analyze the results of treatment of right-sided diaphragmatic hernias in newborns. Materials and methods: a retrospective analysis of the medical records and autopsy protocols of 22 newborns with right-sided diaphragm defect, who were in the clinics of the State Institution «IPAG named after academician O.M. Lukyanova of the National Academy of Medical Sciences of Ukraine», was carried out for the last 37 years. Results: in 3 cases stillbirth was stated, in all live-born children (n=19) with right-sided СDH the defect was symptomatic. Moreover, in 84.2% (n=16) of them, symptoms of the disease occurred immediately after birth, in 10.5% (n=2) – from the first to 6 hours of life, in 5.3% (n=1) – after 24 hours, from birth. Signs of pulmonary hypertension were determined based on the difference between pre- and postductal peripheral blood saturation. Thus, in 62.5% (n=5) of operated children and in 63.6% (n=7) who died at the stages of stabilization, the difference in pre- and postductal saturation was more than 10%, whichindicated the presence of 100% pulmonary hypertension, and blood shunting from right to left, through fetal communications. The time of preoperative stabilization ranged from 1 to 23 days, on average 7.25 days. 8 children were operated. The surgical approach was right-sided subcostal laparotomy (n=5) or right-sided thoracotomy (n=2). In one case, there was a combined approach: right-sided laparotomy + right-sided thoracotomy. 5 children survived, 3 died. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia, right-sided, herniation of the liver, critical hypoplasia of the lungs, surgical correction, newborn baby.

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