Ventral Primary Hernia with Liver Content

Background. Herniation of the liver through the anterior abdominal wall is an extremely rare phenomenon. Most cases occur within an incisional hernia (mostly upper abdomen surgery or cardiac surgery). Only two reports mentioned liver herniation without previous abdominal incision. Case Presentation. We report the case of a 70-year-old woman presenting an epigastric swelling. Radiological findings showed a liver herniation in a primary ventral hernia. This case is the first to have been described requiring semiurgent hernia repair associated with partial liver resection. Conclusion. This case is, to the best of our knowledge, the first case of primary ventral hernia with liver content necessitating wedge resection of the left liver lobe.

Catamenial pneumothorax with partial liver herniation due to diaphragmatic laceration: a case report and literature review

Background Catamenial pneumothorax is generally uncommon, with an incidence of less than 3–6% in women with spontaneous pneumothorax. As few cases of catamenial pneumothorax with diaphragmatic defect and liver herniation have been reported, this case report may be useful for understanding the cause and treatment. This case highlights the importance of the approach for liver hernia in patients with catamenial pneumothorax and endometriosis. Case presentation We report a case of catamenial pneumothorax in a 43-year-old woman with diaphragmatic partial liver hernia who was treated with thoracoscopic surgery. She was diagnosed with a right pneumothorax at menstruation onset. Chest computed tomography showed a nodule protruding above the right diaphragm. We performed thoracoscopic surgery to treat the persistent air leak and biopsied the nodule on the right diaphragm. There were blueberry spots on the diaphragm; the nodule was found to be the herniated liver. The diaphragmatic defect was sutured. Histological examination of the tissue near the partial prolapsed liver revealed endometrial tissue. Conclusions It is speculated that ectopic endometrial tissue in the diaphragm will periodically necrose to become a diaphragmatic tear, which is a pathway for air to enter the thoracic cavity and eventually a herniated liver. Thoracoscopic surgery should be considered in patients with catamenial pneumothorax when a diaphragmatic lesion is suspected.

Recurrent congenital diaphragmatic hernia: A single center experience

Congenital Diaphragmatic Hernia (CDH) occurs in 1:4000 live births. It’s morbidity and mortality rates are significant. Recurrence is one of the recognized complications occurring after a successful initial repair. Poorly known are the rate of recurrence and factors that may influence the re-herniation. Poorly described are its morphology and treatment. Medical records of 95 neonates with CDH who had undergone repair at tertiary pediatric teaching hospital between 2007-2018 were retrospectively reviewed. Prior to surgery, peri-operative and recurrence data were collected. The follow-up was 1 to 12 years after the initial repair. Recurrence occurred in 22/84 (26%) patients. In 5 patients we observed more than one recurrence, total number of 27 (32%) re-herniations; 16/22 (72%) recurrences occurred within first 12 months; 7/27 (26%) recurrences were symptomatic which gives the symptomatic recurrence rate 8.3%; 20/27 (74%) were asymptomatic. There were no significant differences between groups considering LHR, gestational age, birth weight, severity of pre-surgery and post-surgery stabilization period. Significantly higher Apgar scores were in the group without recurrence. Among subjects with recurrent CDH majority had a left-sided defect, no hernia sac, no liver herniation, diaphragm was primarily sutured, abdominal wall primarily closed. Even though none of those factors was significantly related with the recurrence. Recurrence in CDH remains a significant issue for long-term surgical morbidity, especially more apparent in the first year of life. As long as the risk factors of re-herniation remains unclear, the most important seems to be routine follow-up protocol allowing for CDH recurrence detection.

The association of perinatal and clinical factors with outcomes in infants with gastroschisis—a retrospective multicenter study in Finland

The aim of the present study was to assess the prognostic factors for the outcome of gastroschisis in Finland. A retrospective multicenter study of gastroschisis patients born between 1993 and 2015 in four Finnish university hospitals was undertaken, collecting perinatal, surgical, and clinical data of neonates for uni- and multifactorial modeling analysis. The aim of the present study was to identify risk factors for mortality and the composite adverse outcome (death and/or short bowel syndrome or hospital stay > 60 days). Of the 154 infants with gastroschisis, the overall survival rate was 90.9%. In Cox regression analysis, independent risk factors for mortality included liver herniation, pulmonary hypoplasia, relaparotomy for perforation or necrosis, abdominal compartment syndrome, and central line sepsis. Furthermore, a logistic regression analysis identified central line sepsis, abdominal compartment syndrome, complex gastroschisis, and a younger gestational age as independent predictors of the composite adverse outcome.Conclusion: The risk of death is increased in newborns with gastroschisis who have liver herniation, pulmonary hypoplasia, abdominal compartment syndrome, relaparotomy for perforation or necrosis, or central line–associated sepsis. Special care should be taken to minimize the risk of central line sepsis in the clinical setting. What is known:• Gastroschisis is a relatively rare congenital anomaly of the abdominal wall and its incidence is increasing.• Complex gastroschisis has been reported to increase risk of mortality and complications.What is new:• Central line sepsis was found to be independently associated with mortality in gastroschisis patients.• Liver herniation was also significantly associated with mortality.

The Role of the Fetal MRI to Predict the Postnatal Survival in Fetuses with Congenital Diaphragmatic Hernia

Objective: To assess the role of the magnetic resonance imaging (MRI) to predict the postnatal survival in patients with congenital diaphragmatic hernia (CDH). Method: 25 patients with CDH who had fetal MRI between 2015 and 2020 were enrolled in this retrospective study. Patients were divided into two groups according to the postnatal survival at 30 days of age: alive and dead. The fetal MRI images were assessed to calculate the lung-to-liver signal intensity ratio (LLSIR), and the total lung volume (TLV). In addition, the site of the defect (right or left), accompanying liver herniation (present or absent), detectable-ipsilateral lung parenchyma at the apex (present or absent) were also recorded. MRI images were evaluated by two pediatric radiologists. A p value lesser than 0.05 was considered statistically significant. Results: Among 25 fetuses, 6 were alive and 19 were dead within 30 days after birth. The detectable lung parenchyma had a relationship with the alive group (p = 0.023). Observed-to-expected TLV (p = 0.001) and LLSIR (p = 0.023) were significantly lower in the dead group. Using the cutoff values for the observed-to-expected TLV as 0.27 (a sensitivity of 84%, a specificity of 84%) and for the LLSIR as 2.02 (a sensitivity of 89%, a specificity of 67%) were found as predictors for death. Conclusion: The postnatal survival in CDH may be predicted using the observed-to-expected TLV and LLSIR on the fetal MRI. The presence of the detectable-ipsilateral lung parenchyma at the apex may also be associated with the postnatal survival.