Early diagnosis and management of Congenital diaphragmatic hernia

This case report describes the case of a full term girl baby with left congenital diaphragmatic hernia(CDH)born to a 36-year-old mother at 38 weeks of gestation.The baby at birth had an APGAR 8 and birth weight 2.930 kgs.Pre operatively,the baby was ventilated and was kept Nil per oral and continued with Total parenteral nutrition.Nasogastric tube continuous suction was done.The parents were counselled for the surgical repair of CDH.On the third day of life,exploratory laparotomy was performed.5 cm diaphragmatic defect was found.The stomach,pancreas,small bowel,large bowel,and spleen were successfully restored from the left thoracic cavity and the diaphragmatic defect was closed.Post operatively,the baby was breastfed well,thermo regulated,maintained saturation,passed urine and stool and was discharged.

Neurodevelopmental outcome in congenital diaphragmatic hernia: Evaluation, predictors and outcome

To review the reported neurodevelopmental outcome of congenital diaphragmatic hernia(CDH) survivors, identify important predictors of developmental disabilities, and describe the pathophysiological mechanisms contributing to adverse outcome. A Medline search was performed for English-language articles cross-referencing CDH with pertinent search terms. Retrospective, prospective, and longitudinal follow-up studies were examined. The reference lists of identified articles were also searched. Neurodevelopmental dysfunction has been recognized as one of most common and potentially most disabling outcome of CDH. Intelligence appears to be in the low normal to mildly delayed range. Neuromotor dysfunction is common during early childhood. Behavioral problems, hearing impairment, and quality of life related issues are frequently encountered in older children and adolescence. Disease severity correlates with the degree of neurological dysfunction. Neurodevelopmental follow-up in CDH children should become standard of care to identify those who would benefit from early intervention services and improve neurological outcomes.

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Aim: Chylothorax is a recognized complication after surgery for congenital diaphragmatic hernia (CDH) in a neonate. Management strategies for chylothorax include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. It is important to determine which is the better plan for treatment of chylothorax after repair of CDH. The authors report successful management by use of the MCT diet for a neonate with chylothorax after repair of CDH. Case: A male infant weighing 3.0 kg was delivered by cesarean section at 38 weeks of gestation and intubated immediately after birth. Prenatal ultrasonography had disclosed left-sided posterolateral diaphragmatic hernia. After stabilization, surgery was performed via a left-sided transverse supra-abdominal incision. The unfixed colon, small bowel, stomach, and spleen were reduced from the chest with little difficulty. A hernia sac was not present and the left-sided posterolateral diaphragm showed a defect 3.5 cm × 2.0 cm in width. The child was fed via a nasogastric tube starting on postoperative day 4 and dyspnea disappeared. Plain chest X-ray on postoperative day 7 showed left pleural radioopacity. A specimen of the chest drainage examined on postoperative day 10 was typical of lymph, with a triglyceride level of 328 mg/dl. The chest drainage was dark yellowish, and a medium-chain triglyceride formula was used until postoperative day 30, by which time the effusion has disappeared. Discussion: Chylothorax after repair of CDH may be a transient disorder that will resolve after a period of diminished flow through the thoracic lymphatics.

Congenital Diaphragmatic Hernia: A Benin Teaching Hospital Experience

Congenital diaphragmatic hernia is the outcome of the abdominal contents in the thorax by a breach caused by a failure to close the pleuroperitoneal canal. It is a rare and serious disease. Our teaching hospital had registered these seven last years five cases of congenital diaphragmatic hernia, operated, but never published. We report the most recent one, a case of a newborn baby seen at the 5th hour of life for respiratory distress. Initial examination revealed: an asymmetric thorax, respiratory distress with 88% oxygen saturation at ambient air, tachycardia and abolition of vesicular murmur in the left lung field. L-abdomen was flat and soft. Thoraco-abdominal radiography revealed a clear left intra-thoracic image with mass effect on the left lung parenchyma. He has benefited from a reduction of the herniated visceras and a successful closing of the breach. The operation had few after-effects after five months follow-up with a very good recovery of the cardio-pulmonary function.

Congenital Diaphragmatic Hernia Revealed by an Inaugural Diabetic Ketoacidosis in a 9-Year-Old Child

Introduction: Congenital diaphragmatic hernia is often detected during the prenatal or neonatal period by severe respiratory symptoms. Late-presenting congenital diaphragmatic hernia is uncommon entity resulting in frequent misdiagnosis and inappropriate treatment. Case Report: We report the case of a left congenital diaphragmatic hernia revealed by an inaugural diabetic ketoacidosis in a 9-year-old girl. She has presented progressive weight loss without loss of appetite associated with polyuro-polydipsia, then epigastric pain with vomiting. Blood glucose was 3.2 g/L, ketonuria and 2+ glycosuria. Despite a well-conducted treatment, there was persistence of dyspnea. Chest X-ray and chest CT-scan confirmed the presence of a left diaphragmatic hernia. Evolution was marked by the death of the child on day 2 post-operative from a multivisceral failure. Conclusion: Clinical and radiological signs of congenital diaphragmatic hernia after the neonatal period may be difficult to interpret and may result in delayed diagnosis, erroneous treatment and potentially fatal outcome.

Ultrasound diagnosis of congenital Morgagni hernias: Ten years of experience at two Chinese centers

BACKGROUND Morgagni hernias are rare anomalies that are easily misdiagnosed or missed.AIM To summarize the ultrasound(US)imaging characteristics of Morgagni hernias through a comparison of imaging and surgical results.METHODS The records of children with Morgagni hernias who were hospitalized at two hospitals between January 2013 and November 2023 were retrospectively re-viewed in terms of clinical findings,US features,and operative details.RESULTS Between 2013 and 2023,we observed nine(five male and four female)children with Morgagni hernias.Upper abdominal scanning revealed a widening of the prehepatic space,with an abnormal channel extending from the xiphoid process to the right or left side of the thoracic cavity.The channel had intestinal duct and intestinal gas echoes.Hernia contents were found in the transverse colon(n=6),the colon and small intestine(n=2),and the colon and stomach(n=1).Among the patients,seven had a right-sided lesion,two had a left-sided lesion,and all of them had hernial sacs.CONCLUSION US imaging can accurately determine the location,extent,and content of Morgagni hernias.For suspected Mor-gagni hernias,we recommend performing sonographic screening first.

Clinical analysis of congenital diaphragmatic hernia in newborn infants:report of 33 cases

Objective To review the clinical experience of diagnosis and treatment of the congenital diaphragmatic hernia in newborn infants. Methods Thirty-three neonates were diagnosed having congenital diaphragmatic hernia in our hospitalfrom Jan. 1,2004 to Sept. 30,2009. The clinical data was retrospectively reviewed. Results 21 cases were treated

Congenital Diaphragmatic Hernia with Delayed Diagnosis: Report of Two Cases

Introduction: Advances in prenatal imaging studies have allowed early diagnosis of Congenital Diaphragmatic Hernia (CDH), although neonatal mortality remains at high levels (60% survival). Despite advances, this study found delayed diagnosis, demonstrating subdiagnosis, possibly caused by lack of resources and/or prenatal diagnostic failure. Case Report 1: Infant, 4 months and 22 days old, dyspneic, cyanotic, with fever and vomiting for 3 days, treated as pneumonia. After the second chest radiography, a right CDH was revealed. Surgical correction was performed and removal of Meckel’s diverticulum was surgical findings. The patient was discharged on the 10th days after admission. Case Report 2: Infant, 11 months and 3 days old, distended abdomen, with fever and dyspnea for 2 days, treated as pneumonia. After the second chest radiography, a left CDH was revealed. The patient was submitted to surgery, intestinal loop incarceration without necrosis was observed, and the correction of CDH was performed. The patient was discharged on the 7th day after admission. Discussion: Three cases, between July 2012 and July 2013, were diagnosed at Dom Malam Hospital;2 Cases of CDH, with delayed diagnosis, showed incidence of 66.66%. Delayed diagnosis of these patients with initial hypotheses of pneumonia demonstrated high risk, emphasizing the importance of diagnosis research through observation of the clinical course, the correct imaging interpretation, in order to establish early diagnosis and treatment.

Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

Background Following on from an earlier study published in 2008 about left pulmonary artery(LPA)flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia(CDH)and the ratio of LPA to right pulmonary artery(RPA)diameters being a simple and reliable indicator for commencing nitric oxide(NO)therapy,the ratio of LPA:RPA diameters(PA ratio orPAR)was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH better.Methods Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to survival.Data obtained retrospectively for subject demographics,clinical course,LPA/RPA diameters,and PAR were compared between survivors and non-survivors.The value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic(ROC)curve analysis.Results Of 65 subjects,there were 54 survivors(82.3%)and 11 non-survivors(17.7%);7 of 11 non-survivors died before surgical repair could be performed.Mean PAR for survivors(0.851±0.152)was significantly higher than for non-survivors(0.672±0.108)(p=0.0003).Mean PAR for non-survivors was not affected by surgical repair.Characteristics of survivors were:LPA≥2 mm(n=52 of 54;mean PAR=0.866±0.146)and RPA≥3mm(n=46 of 54;mean PAR=0.857±0.152).Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean PAR.ROC curve cut-off for PAR was 0.762.Subjects with high PAR(≥0.762)required high-frequency oscillatory ventilation/NO less than subjects with low PAR(<0.762)(p=0.0244 and p=0.0485,respectively)and subjects with high PAR stabilized significantly earlier than subjects with low PAR(1.71±0.68 days vs 3.20±0.87 days)(p<0.0001).Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH.

Maternal diaphragmatic hernia in pregnancy:A systematic review with a treatment algorithm

BACKGROUND Diaphragmatic hernia(DH)is extremely rarely described during pregnancy.Due to the rarity,there is no diagnostic or treatment algorithm for DH in pregnancy.AIM To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.METHODS Literature search of English-,German-,Spanish-,and Italian-language articles were performed using PubMed(1946–2021),PubMed Central(1900–2021),and Google Scholar.The PRISMA protocol was followed.The search terms included:Maternal diaphragmatic hernia,congenital hernia,pregnancy,cardiovascular collapse,mediastinal shift,abdominal pain in pregnancy,hyperemesis,diaphragmatic rupture during labor,puerperium,hernie diaphragmatique maternelle,hernia diafragmática congenital.Additional studies were identified by reviewing reference lists of retrieved studies.Demographic,imaging,surgical,and obstetric data were obtained.RESULTS One hundred and fifty-eight cases were collected.The average maternal age increased across observed periods.The proportion of congenital hernias increased,while the other types appeared stationary.Most DHs were left-sided(83.8%).The median number of herniated organs declined across observed periods.A working diagnosis was correct in 50%.DH type did not correlate to maternal or neonatal outcomes.Laparoscopic access increased while thoracotomy varied across periods.Presentation of less than 3 days carried a significant risk of strangulation in pregnancy.CONCLUSION The clinical presentation of DH is easily confused with common chest conditions,delaying the diagnosis,and increasing maternal and fetal mortality.Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain,especially when followed by collapse.Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.A proposed algorithm helps manage pregnant women with maternal DH.Strangulated DH requires an emergent operation,while delivery should be based on obstetric indications.

Right Post-Traumatic Diaphragmatic Hernia with Liver Dislocation

Diaphragmatic hernia is a rare consequence of thoraco-abdominal trauma. It may be associated with high morbidity and mortality, particularly if surgical intervention is delayed. We report a case of a right diaphragmatic hernia in a 75-year-old woman. The patient was referred to our hospital with mild dyspnea. Chest radiograph showed an overtly elevated right hemi-diaphragm. Thoracic and abdominal computed tomographic scan was requested and showed a defect of the right diaphragmatic muscle wall with intrathoracic ascension of the liver. During the postoperative course, the patient was still on mechanical ventilation, hemodynamically unstable. She developped urinary peritonitis and an extensive bowel ischemia worsening. We report this case to show that the prognosis is related to associated injuries and possible complications. The possibility of a diaphragmatic rupture should be kept in mind and surgery is mandatory in order to avoid complications.

Non-traumatic diaphragmatic hernia of the liver in an adult:a case report

BACKGROUND: Diaphragmatic hernia of the liver is a rare clinical entity, usually found after trauma in adults. This study was undertaken to elucidate a misdiagnosis of non-traumatic diaphragmatic hernia of the liver in an adult. METHOD: The clinical data of one patient with non-traumatic diaphragmatic hernia of the liver was analyzed. RESULTS: A tumor in the right lower thorax was revealed by chest X-ray and computed tomography. Non-traumatic diaphragmatic hernia of the liver was not identified until the operation. Pathological analysis confirmed the finding. The patient recovered well. CONCLUSIONS: Non-traumatic diaphragmatic hernia of the liver in an adult is a rare right-sided diaphragmatic hernia, which can move up into the chest cavity. It should be distinguished from lung cancer. The diagnosis and evaluation of non-traumatic diaphragmatic hernia of the liver can help optimize surgical management.

Diaphragmatic hernia after right donor and hepatectomy: a rare donor complication of partial hepatectomy for transplantation

BACKGROUND: Because of the critical worldwide shortage of cadaveric organ donors, transplant professionals have increasingly turned to living donors. Partial hepatectomy for adult living donor liver transplantation has been performed since the late 1990s. Most often,the complications of living donor hepatectomy have been related to the biliary tract, specifically biliary leaks. METHODS: A 54-year-old man underwent donor right hepatectomy for living donor liver transplantation. Three years after liver donation he presented with upper abdominal pain and fullness. Radiographic workup revealed a diaphragmatic hernia of the right hemithorax. RESULTS: After thoracoscopic evaluation of the right hemithorax, diaphragmatic hernia was repaired. Currently the patient remains well several months after the repair with complete resolution of abdominal pain, normal chest X-ray examination demonstrating no recurrence of diaphragmatic hernia, and normal liver functions tests. CONCLUSIONS: Multiple complications of living donor liver transplantation have been described the transplant literature. Diaphragmatic hernia is a formerly-undescribed complication of right donor hepatectomy for transplantation.

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

Background:Lung hypoplasia,pulmonary persistent hypertension of the newborn and its morphological changes are the main features in congenital diaphragmatic hernia(CDH).This study was undertaken to investigate if antenatal use of sildenafil and/or bosentan attenuates vascular remodeling,promotes branching,and improves alveolarization in experimental nitrofeninduced CDH.Methods:Nitrofen(100 mg)was gavage-fed to pregnant rats at post conception day(PCD)9 to induce CDH.The rats were randomized to 5 groups:1)control;2)nitrofen;3)nitrofen+sildenafil 100 mg/kg per day at PCD 16-20;4)nitrofen+bosentan 30 mg/kg per day,at PCD 16-20,and 5)nitrofen+bosentan+sildenafil,same doses and administration days.After cesarean delivery,the offsprings were sacrifi ced.The diaphragmatic defect and pulmonary hypoplasia were identified,and the lungs were dissected.Arterial wall thickness,bronchiolar density and alveolarization were assessed.Results:The offsprings with CDH were characterized by severe pulmonary hypoplasia(lung weight-to-body weight ratio:0.0263[95%confidence interval(CI)0.0242-0.0278)]in the nitrofen group versus 0.0385(95%CI 0.0355-0.0424)in the control group(P=0.0001).Pulmonary arterial wall thickness was decreased to 3.0(95%CI 2.8-3.7)μm in the nitrofen+sildenafil group versus 5.0(95%CI 4.1-4.9)μm in the nitrofen group(P=0.02).Terminal bronchioles increased to 13.7(95%CI 10.7-15.2)μm in the nitrofen+bosentan group in contrast to 8.7(95%CI 7.2-9.4)μm in the nitrofen group(P=0.002).More significant differences(P=0.0001)were seen in terminal bronchioles in the nitrofen+sildenafil+bosentan group than in the nitrofen group[14.0(95%CI 12.5-15.4)μm versus 8.5(95%CI 7.1-9.3)μm].Pulmonary arterial wall thickness was also decreased in the former group.Conclusions:In this rat model,antenatal treatment with sildenafil attenuates vascular remodeling.Bosentan promotes the development of terminal bronchioles in nitrofen-induced CDH.

Combination of congenital cleft lip and palate with congenital diaphragmatic hernia: a severe disease course

Congenital cleft lip and palate （CLP） is the most ＇common birth defect now in China. The incidence is 1.62%0 according to the data （1988-- 1992） provided by the National Center for Birth Defects Monitoring. It is also one of the congenital anomalies that have excellent prognosis. But severe complications may occur in the cases accompanied some other deformities. Here we report a case of death caused by left-sided posterolateral congenital diaphragmatic hernia （CDH）, type Bochdalek, after the cleft operation.

Adult congenital diaphragmatic hernia of the liver: a rare case report

Congenital diaphragmatic hernia (CDH), which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adult, especially for those uncommon right CDH [1–4]. Whereas, liver as the main

Traumatic diaphragmatic hernia associated with pelvic fractures: a case report and literature review

Objective： To review the epidemiological feature, clinical, and diagnostic data of post-traumatic diaphragmatic hernia （TDH） associated with pelvic fractures patients reported in recent 10 years. Methods： One case of delayed presentation of TDH after pelvic fractures taken place one month later was present, with a review on the literature of this kind of patients in our country. Results： The incidence of TDH associated with pelvic fractures was relatively rare, and the diagnosis were often delayed or missed. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality was 8.51%. Conclusion： TDH associated with pelvic fractures is difficult to diagnose because of their varied clinical and radiological signs and the patients may not present with symptoms for a long time following the injury. In clinical, a high index of suspicion with appropriate examination is the mainstays of management, which can also increase the prognosis.

Laparoscopic repair of diaphragmatic hernia associating with radiofrequency ablation for hepatocellular carcinoma:A case report

BACKGROUND Radiofrequency ablation(RFA)is an effective treatment for early-stage hepatocellular carcinoma(HCC).Although RFA is a relatively safe technique compared with surgery,several complications have been reported to be following/accompanying this treatment.Delayed diaphragmatic hernia caused by RFA is rare;however,the best surgical approach for its treatment is uncertain.We present a case of laparoscopic repair of diaphragmatic hernia due to RFA.CASE SUMMARY An 80-year-old woman with segment VIII HCC was treated twice in 5 years with RFA;28 mo after the second RFA,the patient complained of right hypochondriac pain.Computed tomography revealed that the small intestine was incarcerated in the right thorax.The patient was diagnosed with diaphragmatic hernia and underwent laparoscopic repair by non-absorbable running sutures.The patient’s postoperative course was favorable,and the patient was discharged on postoperative day 12.The diaphragmatic hernia has not recurred 24 mo after surgery.CONCLUSION Laparoscopic treatment of iatrogenic diaphragmatic hernia is effective and minimally invasive.

Intestinal gangrene secondary to congenital transmesenteric hernia in a child misdiagnosed with gastrointestinal bleeding: A case report

BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is not widely known among clinicians,and it is easily misdiagnosed,resulting in disastrous effects.CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer.The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first.Then,the patient’s symptoms were aggravated and he presented in a shock-like state.Computed tomography revealed a suspected internal hernia,extensive small intestinal obstruction,and massive effusion in the abdominal and pelvic cavity.Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve,and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis.The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.CONCLUSION In this report,we review the pathogenesis,presentation,diagnosis,and treatment of congenital transmesenteric hernia in children.

Post Traumatic Diaphragmatic Hernia Revealing a Colonic Tumor

Post traumatic diaphragmatic injuries have long been known. However their varied clinical, expressions lead to difficulties which cause its delay. The occurrence of herniation of hollow viscera in the thoracic cavity followed by its necrosis or perforation, is a delayed complication, a rare entity with a poor prognosis. The discovery of a colonic tumor in a diaphragmatic hernia is an exceptional clinical circumstance. Here we report the case of a patient with a complicated diaphragmatic hernia, whose symptoms are precipitated by the presence of a colon stenosing tumor. The management consisted of an exclusive laparotomy had allowed dealing in one surgical intervention with both the abdominal and thoracic injuries.