LATE PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA – A  CASE SERIES

With an incidence of 1 to 2500 to 1 to 5000 births, congenital diaphragmatic hernia (CDH) can be a life-threatening condition. In 5-25% of the cases, CDH can present at older ages with non-specific signs and symptoms. The aim of our study was to assess the clinical aspects, the diagnosis and management of the patients with this affliction as well as increase the level of awareness on late-presenting CDH. Five patients older than 1 year of age at the moment of diagnosis of CDH were included in the study. The patients presented either for respiratory symptoms or gastrointestinal one. In all the cases, during initial assess, plain chest or abdominal x-rays were performed leading to the diagnosis of congenital diaphragmatic hernia. After further imaging studies (CT scans, ultrasound) all the patients underwent surgery for defect closure, 3 of them by the classic approach, 1 by laparoscopy and 1 by thoracoscopy. Three patients had left diaphragmatic defect and 2 had an anterior diaphragmatic defect. We extensively present the case of a 14-year-old female patient with a posterolateral diaphragmatic defect, in which gastric necrosis was found during surgery, leading to partial gastric resection and esogastric anastomosis. In this case, the postoperative evolution was critical and thepatient died in the 9th day postoperatively. The evolution of the other 4 patients was uneventful.

Download Full-text

Tetralogy of Fallot with congenital diaphragmatic hernia and left lung hypoplasia: assessment of the adequacy of the peripheral pulmonary vascular growth after hernia repair

Cardiology in the Young ◽

10.1017/s104795111100134x ◽

2011 ◽

Vol 22 (2) ◽

pp. 235-238 ◽

Cited By ~ 3

Author(s):

Hong Ju Shin ◽

Won Kyoung Jhang ◽

Tae Jin Yun

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Tetralogy Of Fallot ◽

Diaphragmatic Hernia ◽

Left Lung ◽

Lung Hypoplasia ◽

Vascular Growth ◽

Threatening Condition ◽

Central Pulmonary Artery ◽

Life Threatening ◽

Vascular Beds

AbstractCongenital diaphragmatic hernia is a life-threatening condition frequently associated with various congenital cardiac diseases. In congenital diaphragmatic hernia associated with tetralogy of Fallot, central pulmonary artery size of the affected side may not reflect the capacitance of peripheral pulmonary vascular beds. We report a case of congenital diaphragmatic hernia associated with tetralogy of Fallot, which was repaired after assessing the adequacy of the pulmonary vascular beds by intra-operative pulmonary blood flow study.

Download Full-text

Tension gastrothorax in late-onset congenital diaphragmatic hernia, a rare but life-threatening condition

Medicine ◽

10.1097/md.0000000000024815 ◽

2021 ◽

Vol 100 (7) ◽

pp. e24815

Author(s):

In-Hag Song

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Late Onset ◽

Threatening Condition ◽

Life Threatening ◽

Tension Gastrothorax

Download Full-text

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

Tropical Doctor ◽

10.1177/0049475520959906 ◽

2021 ◽

Vol 51 (1) ◽

pp. 10-15

Author(s):

Kenneth V Iserson ◽

Sri Devi Jagjit ◽

Balram Doodnauth

Keyword(s):

Aortic Dissection ◽

Correct Diagnosis ◽

Signs And Symptoms ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms ◽

Handheld Device ◽

Thoracic Aortic Dissection ◽

Threatening Condition ◽

Life Threatening ◽

Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

Download Full-text

Congenital Diaphragmatic Hernia: Demographics and 30-day Outcomes in Adults

The American Surgeon ◽

10.1177/0003134820960061 ◽

2020 ◽

pp. 000313482096006

Author(s):

Joseph G. Brungardt ◽

Quinn A. Nix ◽

Kurt P. Schropp

Keyword(s):

Postoperative Complications ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Pediatric Population ◽

Case Series ◽

National Database ◽

Improvement Program ◽

American College Of Surgeons ◽

Postoperative Diagnosis ◽

Acs Nsqip Database

Background Congenital diaphragmatic hernia (CDH) is a pathology most often affecting the pediatric population, although adults can also be affected. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with postoperative diagnosis of CDH, distinct from ventral hernia. Two groups were created based upon surgical approach of open or minimally invasive (MIS) repair. Baseline demographics and outcomes were compared. Results 110 patients undergoing surgical correction of CDH were captured in the database. We found rates of return to the operating room (4.55%), postoperative respiratory failure (5.45%), and reintubation (3.64%) with no difference between groups. There was no mortality and no difference between groups in length of operation, discharge to home, or postoperative complications. Patients undergoing open repair had a longer length of stay than patients in the MIS group (6.47 ± 10.76 days vs. 3.68 ± 3.74 days, P = .0471). Mesh was used in MIS more often than the open group (47.30% vs. 5.56%, P < .0001). Discussion This study describes rates of postoperative complications in patients undergoing repair of CDH, and suggests outcomes those are equivalent between patients receiving open or MIS approaches. Further case series or retrospective studies are needed to further describe this population of patients.

Download Full-text

A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa441 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Salvador Recinos ◽

Sabrina Barillas ◽

Alejandra Rodas ◽

Javier Ardebol

Keyword(s):

Right Ventricular Dysfunction ◽

Signs And Symptoms ◽

Fat Embolism ◽

Fat Infiltration ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Bone Marrow Harvesting ◽

Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

Download Full-text

Light at the end of the tunnel: a technical note on thoracoscopic repair of congenital diaphragmatic hernia

Surgical Techniques Development ◽

10.4081/std.2011.e6 ◽

2011 ◽

Vol 1 (1) ◽

pp. 6

Author(s):

Claire R. Jackson ◽

Gordan A. MacKinlay ◽

Merrill McHoney

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Postoperative Recovery ◽

Technical Note ◽

Diaphragmatic Defect ◽

Hernia Sac ◽

Thoracoscopic Repair ◽

Technical Learning ◽

Number Of Authors

Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described by a number of authors and is increasingly widely practiced. We present a technical learning point. CDH is associated with the presence of a hernia sac in around 20% of all cases. In this case the presence of a ruptured hernia sac complicated the thoracoscopic repair of a left sided CDH, as it was initially difficult to recognise. Once the anatomy was clarified the repair was satisfactorily completed and the child made a rapid postoperative recovery. This technical note is to warn other surgeons that a tunnel like appearance of the diaphragmatic defect may in fact be due to the presence of a torn hernia sac, which requires excision before closure of the defect.

Download Full-text

Cellular Origin(s) of Congenital Diaphragmatic Hernia

Frontiers in Pediatrics ◽

10.3389/fped.2021.804496 ◽

2021 ◽

Vol 9 ◽

Author(s):

Gabriëla G. Edel ◽

Gerben Schaaf ◽

Rene M. H. Wijnen ◽

Dick Tibboel ◽

Gabrielle Kardon ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Birth Defect ◽

Congenital Disorder ◽

Diaphragmatic Defect ◽

Lung Hypoplasia ◽

Cellular Origin ◽

Recent Developments ◽

Mechanical Factors

Congenital diaphragmatic hernia (CDH) is a structural birth defect characterized by a diaphragmatic defect, lung hypoplasia and structural vascular defects. In spite of recent developments, the pathogenesis of CDH is still poorly understood. CDH is a complex congenital disorder with multifactorial etiology consisting of genetic, cellular and mechanical factors. This review explores the cellular origin of CDH pathogenesis in the diaphragm and lungs and describes recent developments in basic and translational CDH research.

Download Full-text

Right ventricular thrombus, a challenge in imaging diagnostics: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab340 ◽

2021 ◽

Author(s):

Massimo Barbagallo ◽

Daryl Naef ◽

Pascal Köpfli ◽

Urs Hufschmid ◽

Tilo Niemann ◽

...

Keyword(s):

Right Ventricular ◽

Case Series ◽

General Medicine ◽

High Sensitivity ◽

Cost Effective ◽

Ventricular Thrombus ◽

Threatening Condition ◽

Life Threatening ◽

Therapeutic Decision Making ◽

Sensitivity Specificity

Abstract Background Presence of right ventricular thrombus (RVT) is a rare but life-threatening condition, thus immediate diagnosis and therapy are mandatory. Unfortunately, detection and distinction from intraventricular tumor masses or vegetations represents a complex task. Furthermore, consecutive therapy is principally led by clinical presentation without considering morphological features of the thrombus. Current literature suggests a multimodal non-invasive imaging approach. In this paper, we discuss the role of cardiac magnetic resonance (CMR) for the detection of RVT in patients with pulmonary embolism (PE). We consider the relatively expensive and not broadly available imaging procedure and weigh it up to its assumed high sensitivity, specificity and importance for differential diagnosis and therapeutic decision making. Case Summary In this case series we report three cases of RVT with concomitant PE, whereof two were missed during routine cardiac workup by transthoracic echocardiography (TTE) and computer tomography (CT). CMR led to detection and further characterization of the thrombi in both cases. These patients were diagnosed and treated at the Cantonal Hospital of Baden in the division of General Medicine. Conclusions CMR reliably detects and characterizes RVT, even under unfavourable conditions for echocardiography such as arrhythmia, adiposity or in posterior position of RVT. Obtained information could facilitate the choice of therapeutic approach (anticoagulation vs. systemic lysis, vs. surgical thrombectomy). Future risk-stratification scores will promote cost-effective use of CMR.

Download Full-text

P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

British Journal of Surgery ◽

10.1093/bjs/znab395.032 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Mehmet Gunay ◽

gorkem uzunyolcu ◽

yalın iscan ◽

kaan gok ◽

hakan yanar ◽

...

Keyword(s):

Total Gastrectomy ◽

Diaphragmatic Hernia ◽

Emergency Surgery ◽

Penetrating Trauma ◽

Abdominal Symptoms ◽

Threatening Condition ◽

Segmental Bowel Resection ◽

Life Threatening ◽

Surgery Department ◽

Laparoscopic Techniques

Abstract Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

Download Full-text