Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report

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Muroni Mirko

2010-08-01

Full Text Available Abstract Introduction Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Case presentation We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired. Conclusions This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.

Natural history of extensive diaphragmatic injury on the right side: experimental study in rats

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Jorge Henrique Rivaben

2014-08-01

Full Text Available OBJECTIVE: To evaluate the natural healing of the rat diaphragm that suffered an extensive right penetrating injury.METHODS: Animals were submitted to an extensive penetrating injury in right diaphragm. The sample consisted of 40 animals. The variables studied were initial weight, weight 21 days after surgery; healing of the diaphragm, non-healing of the diaphragm, and herniated abdominal contents into the chest.RESULTS: Ten animals were used as controls for weight and 30 animals were operated. Two animals died during the experiment, so 28 animals formed the operated group; healing of the diaphragm occurred in 15 animals (54%, 11 other animals showed diaphragmatic hernia (39% and in two we observed only diaphragmatic injury without hernia (7%. Among the herniated organs, the liver was found in 100% of animals, followed by the omentum in 77%, small bowel in 62%, colon in 46%, stomach in 31% and spleen in 15%. The control group and the diaphragmatic healing subgroup showed increased weight since the beginning of the study and the 21 days after surgery (p <0.001. The unhealed group showed no change in weight (p = 0.228.CONCLUSION: there is a predominance of spontaneous healing in the right diaphragm; animals in which there was no healing of the diaphragm did not gain weight, and the liver was the organ present in 100% the diaphragmatic surface in all rats with healed diaphragm or not.

Difficult weaning in delayed onset diaphragmatic hernia

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Ahmed Syed

2009-01-01

Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

Sphingolipids in Congenital Diaphragmatic Hernia; Results from an International Multicenter Study.

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Kitty G Snoek

Full Text Available Congenital diaphragmatic hernia is a severe congenital anomaly with significant mortality and morbidity, for instance chronic lung disease. Sphingolipids have shown to be involved in lung injury, but their role in the pathophysiology of chronic lung disease has not been explored. We hypothesized that sphingolipid profiles in tracheal aspirates could play a role in predicting the mortality/ development of chronic lung disease in congenital diaphragmatic hernia patients. Furthermore, we hypothesized that sphingolipid profiles differ between ventilation modes; conventional mechanical ventilation versus high-frequency oscillation.Sphingolipid levels in tracheal aspirates were determined at days 1, 3, 7 and 14 in 72 neonates with congenital diaphragmatic hernia, born after > 34 weeks gestation at four high-volume congenital diaphragmatic hernia centers. Data were collected within a multicenter trial of initial ventilation strategy (NTR 1310.36 patients (50.0% died or developed chronic lung disease, 34 patients (47.2% by stratification were initially ventilated by conventional mechanical ventilation and 38 patients (52.8% by high-frequency oscillation. Multivariable logistic regression analysis with correction for side of the defect, liver position and observed-to-expected lung-to-head ratio, showed that none of the changes in sphingolipid levels were significantly associated with mortality /development of chronic lung disease. At day 14, long-chain ceramides 18:1 and 24:0 were significantly elevated in patients initially ventilated by conventional mechanical ventilation compared to high-frequency oscillation.We could not detect significant differences in temporal sphingolipid levels in congenital diaphragmatic hernia infants with mortality/development of chronic lung disease versus survivors without development of CLD. Elevated levels of ceramides 18:1 and 24:0 in the conventional mechanical ventilation group when compared to high

Thoracoscopic approach in management of congenital diaphragmatic hernia.

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Liem, Nguyen Thanh

2013-10-01

Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2%). There were no intraoperative deaths. 38 patients died postoperatively (13.5%).

Diaphragmatic Hernia Masquerading as Pleural Effusion

African Journals Online (AJOL)

As many as 30% of diaphragmatic hernias present late.[1] We present an unusual case report of a late presentation of isolated diaphragmatic injury, after apparently minor blunt trauma, which was initially misdiagnosed as pleural effusion. CASE REPORT. A 40-year-old man slipped and fell against the edge of his bath tub.

Diaphragmatic hernia: diagnostic approaches with review of the literature

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Eren, Suat [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)]. E-mail: suateren@atauni.edu.tr; Ciris, Fahri [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)

2005-06-01

Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate the management of DH. We reviewed the diaphragmatic hernia types associated with our cases, and we discussed the preferred imaging modalities for different DHs with review of the literature. We evaluated the imaging findings of 21 DH cases. They were Morgagni's hernia (n = 4), Bochdalek hernia (n = 2), iatrogenic DH (n = 4), traumatic DH (n = 6), and hiatal hernia (n = 5). Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. With high sensitivity for soft tissue, MR imaging may be performed in the selected patients, on the late presenting DH cases or on the cases of the diagnosis still in doubt especially.

Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis

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Cristina Vilhena

2015-01-01

Full Text Available Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia.

Comparison of Radiography and Ultrasonography for Diagnosis of Diaphragmatic Hernia in Bovines

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Hakim Athar

2010-01-01

Full Text Available The present study was conducted on 101 animals suffering from thoracoabdominal disorders; out of which twenty seven animals (twenty six buffaloes and one cow were diagnosed with diaphragmatic hernia based on clinical signs, radiography, ultrasonography, and left flank laparorumenotomy. Radiography alone confirmed diaphragmatic hernia in 18 cases (66.67% with a sac-like structure cranial to the diaphragm. In 15 animals the sac contained metallic densities while in three cases a sac-like structure with no metallic densities was present. Ultrasonography was helpful in confirming diaphragmatic hernia in 23 cases (85.18% and ultrasonographically reticular motility was evident at the level of 4th/5th intercostal space in all the animals. B+M mode ultrasonography was used for the first time for diagnosis of diaphragmatic hernia in bovines and the results suggested that ultrasonography was a reliable diagnostic modality for diaphragmatic hernia in bovines.

In need of a patch UP: Recurrent congenital diaphragmatic hernia presenting with a large pleural effusion

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Farhana Shariff

2014-10-01

Full Text Available We report a case of recurrent congenital diaphragmatic hernia (CDH presenting with a large unilateral pleural effusion. A 12-year old boy who had a left sided CDH repaired in the neonatal period, presented with fever, lethargy, and non-productive cough. Chest radiograph demonstrated a loculated pleural effusion. Computed tomography scan revealed recurrent herniation of abdominal contents. To our knowledge, this is the first reported case of a recurrent congenital diaphragmatic hernia presenting with large pleural effusion.

Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication

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Pradeep Kajal

Full Text Available Introduction: Congenital diaphragmatic hernia (CDH is a defect in diaphragm which usually presents with severe respiratory distress in neonatal period. Presentation of case: We present a case of congenital diaphragmatic hernia presenting at an age of 2.5 years in a male child. It was misdiagnosed as a case of pyothorax for which chest tube was attempted on left side resulting in iatrogenic gastric perforation. The patient was managed by early and prompt surgery. Discussion: Late presentation is usually rare with vast array of respiratory and gastrointestinal symptoms. It often leads to clinical and radiological misdiagnosis. Conclusion: Surgical intervention in misdiagnosed cases can lead to catastrophic iatrogenic complications. Keywords: Case report, Congenital diaphragmatic hernia, Pyothorax, Chest tube, Iatrogenic gastric perforation

Recurrent Congenital Diaphragmatic Hernia in Ehlers-Danlos Syndrome

International Nuclear Information System (INIS)

Lin, I.C.; Ko, S.F.; Shieh, C.S.; Huang, C.F.; Chien, S.J.; Liang, C.D.

2006-01-01

Ehlers-Danlos syndrome (EDS) includes a group of connective tissue disorders with abnormal collagen metabolism and a diverse clinical spectrum. We report two siblings with EDS who both presented with congenital diaphragmatic hernia (CDH). The elder sister suffered from recurrent diaphragmatic hernia twice and EDS was overlooked initially. Echocardiography as well as contrast-enhanced magnetic resonance angiography (MRA) showed dilatation of the pulmonary artery, and marked elongation and tortuosity of the aorta and its branches. A diagnosis of EDS was eventually established when these findings were coupled with the clinical features of hyperelastic skin. Her younger brother also had similar features. This report emphasizes that EDS may present as CDH in a small child which could easily be overlooked. Without appropriate surgery, diaphragmatic hernia might occur. Echocardiographic screening is recommended in patients with CDH. Contrast-enhanced MRA can be helpful in delineation of abnormally tortuous aortic great vessels that are an important clue to the early diagnosis of EDS

Chronic diaphragmatic hernia in 34 dogs and 16 cats.

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Minihan, Anne C; Berg, John; Evans, Krista L

2004-01-01

Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.

Laparoscopic diaphragmatic hernia repair using expanded polytetrafluoroethylene (ePTFE) for delayed traumatic diaphragmatic hernia.

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Jee, Yeseob

2017-06-01

Traumatic diaphragmatic hernia (TDH) is an uncommon surgical problem, and diagnosis is often delayed. However, the mortality from bowel necrosis can reach 80%. Therefore, suspicion is needed and surgery is required to prevent complications. A 50-year-old man was transferred due to abdominal pain and vomiting. Chest X-ray and computed tomography (CT) scan showed herniation of the stomach through the left diaphragm. The patient had fallen down 15 months ago and CT scan at that time revealed a small defect of the diaphragm without herniation. We diagnosed delayed herniation of TDH and the patient underwent laparoscopic repair using an expanded polytetrafluoroethylene (ePTFE) mesh. Recovery was uneventful and the CT scan at 3 months after the operation showed no recurrence. We reported a delayed presenting TDH and considered a laparoscopic approach to be safe and feasible during elective surgery. Moreover, use of an ePTFE mesh for repair of large diaphragmatic hernia was also feasible.

Congenital peritoneopericardial diaphragmatic hernia in a terrier dog

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Reza Kheirandish

2014-06-01

Full Text Available A one-month-old male terrier dog was referred in shock status with a history of anorexia, tachypnea, abdominal distention and progressive weight loss. Auscultation of right side of the lungs found enhanced respiratory noises. The thorough auscultation of the opposite side of the chest revealed the presence of typical intestinal sounds. Cardiac auscultation revealed muffled heart sounds and a diminished palpable precordial cardiac impulse was evident. The radiograph showed the presence of gas within the bowel in abrupt contrast to the adjacent structures of soft tissue opacity. Conservative treatment was failed and the animal died. At necropsy, cranial displacement of abdominal viscera into the pericardial sac was seen. A definitive diagnosis of peritoneopericardial diaphragmatic hernia was made. Although congenital pericardial diseases are rare in dogs, awareness of the clinical manifestation of these kinds of defects combined with early use of available imaging modalities can yield a preoperative diagnosis.

Growth Patterns of Fetal Lung Volumes in Healthy Fetuses and Fetuses With Isolated Left-Sided Congenital Diaphragmatic Hernia.

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Ruano, Rodrigo; Britto, Ingrid Schwach Werneck; Sananes, Nicolas; Lee, Wesley; Sangi-Haghpeykar, Haleh; Deter, Russell L

2016-06-01

To evaluate fetal lung growth using 3-dimensional sonography in healthy fetuses and those with congenital diaphragmatic hernia (CDH). Right and total lung volumes were serially evaluated by 3-dimensional sonography in 66 healthy fetuses and 52 fetuses with left-sided CDH between 20 and 37 weeks' menstrual age. Functions fitted to these parameters were compared for 2 groups: (1) healthy versus those with CDH; and (2) fetuses with CHD who survived versus those who died. Fetal right and total lung volumes as well as fetal observed-to-expected right and total lung volume ratios were significantly lower in fetuses with CDH than healthy fetuses (Pvolume ratios did not vary with menstrual age in healthy fetuses or in those with CDH (independent of outcome). Lung volume rates were lower in fetuses with left-sided CDH compared to healthy fetuses, as well as in fetuses with CDH who died compared to those who survived. The observed-to-expected right and total lung volume ratios were relatively constant throughout menstrual age in fetuses with left-sided CDH, suggesting that the origin of their lung growth abnormalities occurred before 20 weeks and did not progress. The observed-to-expected ratios may be useful in predicting the outcome in fetuses with CDH independent of menstrual age. © 2016 by the American Institute of Ultrasound in Medicine.

Congenital diaphragmatic hernia with concurrent aplasia of the pericardium in a foal.

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Tăbăran, Alexandru-Flaviu; Nagy, Andras Laszlo; Cătoi, Cornel; Morar, Iancu; Tăbăran, Alexandra; Mihaiu, Marian; Bolfa, Pompei

2015-12-30

In veterinary medicine congenital abnormalities of the diaphragm and pericardium are rare, idiopathic malformations, being reported mainly in dogs. This report documents an unusual case of developmental defects in a foal consisting of diaphragmatic hernia concurrent with pericardial aplasia. Following a normal delivery, a full term, female Friesian stillborn foal with the placenta was presented for necropsy. External morphological examination indicated a normally developed foal. At necropsy, a large oval defect (approximately 20 × 15 cm in size) was observed in the left-dorsal side of the diaphragm (left lumbocostal triangle). This defect allowed the intestinal loops, spleen and partially the liver to translocate into the thorax. The loops of the left ascending colon, including the pelvic flexure and partially the small intestine covered the cranial and dorsal posterior parts of the heart due to the complete absence of the left pericardium. The remaining pericardium presented as a white, semi-transparent strip, partially covering the right side of the heart. The left lung and the main bronchus were severely hypoplastic to approximately one-fifth the size of their right homologue. The intermediate part of the liver, containing mainly the enlarged quadrate lobe was translocated in the thorax, severely enlarged and showed marked fibrosis. Histologically in the herniated lobes we diagnosed hepatic chronic passive congestion, telangiectasia and medial hypertrophy of blood vessels. Concomitant malformation involving diaphragmatic hernia and pericardial aplasia in horses have not been previously reported. Moreover, this is the first case describing pericardial aplasia in horse.

Laparoscopic repair of Morgagni diaphragmatic hernia in children ...

African Journals Online (AJOL)

Minimal invasive surgery allows for excellent visualisation of the diaphragm, and is increasingly used for the repair of diaphragmatic hernias in children. This report describes laparoscopic repairs between 2001 and 2007 of four Morgagni hernias in children. All defects were treated successfully using the laparoscopic ...

Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax

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Lingohr P

2014-02-01

Full Text Available Philipp Lingohr,1 Thomas Galetin,2 Boris Vestweber,2 Hanno Matthaei,1 Jörg C Kalff,1 Karl-Heinz Vestweber2 1Department of Surgery, University of Bonn, Bonn, Germany; 2Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany Purpose: Diaphragmatic hernias (DHs are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. Keywords: bilateral diaphragmatic hernia, enterothorax, conventional hernia repair, PERMACOL™, biological implant, diaphragm replacement, mesh repair

Histogram based analysis of lung perfusion of children after congenital diaphragmatic hernia repair.

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Kassner, Nora; Weis, Meike; Zahn, Katrin; Schaible, Thomas; Schoenberg, Stefan O; Schad, Lothar R; Zöllner, Frank G

2018-05-01

To investigate a histogram based approach to characterize the distribution of perfusion in the whole left and right lung by descriptive statistics and to show how histograms could be used to visually explore perfusion defects in two year old children after Congenital Diaphragmatic Hernia (CDH) repair. 28 children (age of 24.2±1.7months; all left sided hernia; 9 after extracorporeal membrane oxygenation therapy) underwent quantitative DCE-MRI of the lung. Segmentations of left and right lung were manually drawn to mask the calculated pulmonary blood flow maps and then to derive histograms for each lung side. Individual and group wise analysis of histograms of left and right lung was performed. Ipsilateral and contralateral lung show significant difference in shape and descriptive statistics derived from the histogram (Wilcoxon signed-rank test, phistogram derived parameters. Histogram analysis can be a valuable tool to characterize and visualize whole lung perfusion of children after CDH repair. It allows for several possibilities to analyze the data, either describing the perfusion differences between the right and left lung but also to explore and visualize localized perfusion patterns in the 3D lung volume. Subgroup analysis will be possible given sufficient sample sizes. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment and reduction of diaphragmatic tension during hiatal hernia repair.

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Bradley, Daniel Davila; Louie, Brian E; Farivar, Alexander S; Wilshire, Candice L; Baik, Peter U; Aye, Ralph W

2015-04-01

During hiatal hernia repair there are two vectors of tension: axial and radial. An optimal repair minimizes the tension along these vectors. Radial tension is not easily recognized. There are no simple maneuvers like measuring length that facilitate assessment of radial tension. The aims of this project were to: (1) establish a simple intraoperative method to evaluate baseline tension of the diaphragmatic hiatal muscle closure; and, (2) assess if tension is reduced by relaxing maneuvers and if so, to what degree. Diaphragmatic characteristics and tension were assessed during hiatal hernia repair with a tension gage. We compared tension measured after hiatal dissection and after relaxing maneuvers were performed. Sixty-four patients (29 M:35F) underwent laparoscopic hiatal hernia repair. Baseline hiatal width was 2.84 cm and tension 13.6 dag. There was a positive correlation between hiatal width and tension (r = 0.55) but the strength of association was low (r (2) = 0.31). Four different hiatal shapes (slit, teardrop, "D", and oval) were identified and appear to influence tension and the need for relaxing incision. Tension was reduced by 35.8 % after a left pleurotomy (12 patients); by 46.2 % after a right crural relaxing incision (15 patients); and by 56.1 % if both maneuvers were performed (6 patients). Tension on the diaphragmatic hiatus can be measured with a novel device. There was a limited correlation with width of the hiatal opening. Relaxing maneuvers such as a left pleurotomy or a right crural relaxing incision reduced tension. Longer term follow-up will determine whether outcomes are improved by quantifying and reducing radial tension.

Genetics Home Reference: congenital diaphragmatic hernia

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... of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of ... occur? How can gene mutations affect health and development? More about Mutations and ... is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature ...

A fatal case of complicated congenital peritoneopericardial diaphragmatic hernia in a Holstein calf

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Hicks, Keltie A.; Britton, Ann P.

2013-01-01

Congenital peritoneopericardial diaphragmatic hernia is a rare condition most commonly reported in cats and dogs. A 6-week-old Holstein heifer calf with a congenital peritoneopericardial diaphragmatic hernia complicated by a perforated abomasal ulcer is described. The clinical signs and pathological findings are compared with those reported in other species.

A fatal case of complicated congenital peritoneopericardial diaphragmatic hernia in a Holstein calf

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Hicks, Keltie A.; Britton, Ann P.

2013-01-01

Congenital peritoneopericardial diaphragmatic hernia is a rare condition most commonly reported in cats and dogs. A 6-week-old Holstein heifer calf with a congenital peritoneopericardial diaphragmatic hernia complicated by a perforated abomasal ulcer is described. The clinical signs and pathological findings are compared with those reported in other species. PMID:24155464

Congenital diaphragmatic hernia as a part of Nance-Horan syndrome?

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Kammoun, Molka; Brady, Paul; De Catte, Luc; Deprest, Jan; Devriendt, Koenraad; Vermeesch, Joris Robert

2018-03-01

Nance-Horan syndrome is a rare X-linked developmental disorder characterized by bilateral congenital cataract, dental anomalies, facial dysmorphism, and intellectual disability. Here, we identify a patient with Nance-Horan syndrome caused by a new nonsense NHS variant. In addition, the patient presented congenital diaphragmatic hernia. NHS gene expression in murine fetal diaphragm was demonstrated, suggesting a possible involvement of NHS in diaphragm development. Congenital diaphragmatic hernia could result from NHS loss of function in pleuroperitoneal fold or in somites-derived muscle progenitor cells leading to an impairment of their cells migration.

Radionuclide scintigraphy in detection of gastroesophageal reflux in survivors of congenital diaphragmatic hernia

International Nuclear Information System (INIS)

Thomas, E.J.; Bharathi Dasan, J.; Patel, C.D.; Bal, C.S.; Malhotra, A.; Kumar, R.; Mitra, D.K.; Agarwala, S.; Padhy, A.K.

2003-01-01

Gastro-esophageal Reflux is a common cause of long-term morbidity in survivors of congenital diaphragmatic hernia. The present retrospective analysis was undertaken to find out the incidence of GER in survivors of congenital diaphragmatic hernia (CDH). A total of 26 survivors of congenital diaphragmatic hernia with a mean age of 19 months were studied. Of these, only 7 had clinical symptoms suggestive of GER such as recurrent respiratory tract infection, vomiting, regurgitation, and epigastric pain. The remaining 19 were asymptomatic and had radionuclide scintigraphy for detection of GER as a part of routine follow-up. All the 26 underwent radionuclide scintigraphy with 100-200 μCi (3.7 -7.4MBq) of Tc99m-Sulphur Colloid. GER was detected in 11 out of 26 patients (4 out of 7 symptomatic patients and 7 out of 19 asymptomatic patients). We concluded that there is high incidence of GER in survivors of congenital diaphragmatic hernia and these patients should be followed up for GER regularly. Scintiscanning being a simple, noninvasive test, may be used for initial evaluation and follow-up of survivors of CDH for GER. (author)

Traumatic diaphragmatic hernia in a 5-month-old boxer dog.

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Hoddinott, Katie

2013-05-01

A 5-month-old intact male boxer dog was presented to the Metro Animal Emergency Clinic, Dartmouth, Nova Scotia after being hit by a car. Radiography identified a diaphragmatic hernia with the stomach herniated into the thoracic cavity. Diaphragmatic herniorrhaphy and splenectomy were performed without complication. The patient returned to his regular active lifestyle.

Blunt bilateral diaphragmatic rupture—A right side can be easily missed

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Maria Michailidou

2015-12-01

Full Text Available Blunt diaphragmatic rupture (BDR is uncommon with a reported incidence range of 1%–2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury. Keywords: Blunt, Diaphragm, Bilateral, Injury

Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002).

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Gibson, Thomas W G; Brisson, Brigitte A; Sears, William

2005-07-01

To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. Retrospective study. 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

Congenital diaphragmatic hernia-associated pulmonary hypertension.

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Harting, Matthew T

2017-06-01

Congenital diaphragmatic hernia (CDH) is a complex entity wherein a diaphragmatic defect allows intrathoracic herniation of intra-abdominal contents and both pulmonary parenchymal and vascular development are stifled. Pulmonary pathology and pathophysiology, including pulmonary hypoplasia and pulmonary hypertension, are hallmarks of CDH and are associated with disease severity. Pulmonary hypertension (PH) is sustained, supranormal pulmonary arterial pressure, and among patients with CDH (CDH-PH), is driven by hypoplastic pulmonary vasculature, including alterations at the molecular, cellular, and tissue levels, along with pathophysiologic pulmonary vasoreactivity. This review addresses the basic mechanisms, altered anatomy, definition, diagnosis, and management of CDH-PH. Further, emerging therapies targeting CDH-PH and PH are explored. Published by Elsevier Inc.

Diaphragmatic Hernia Masquerading as Pleural Effusion | Nalladaru ...

African Journals Online (AJOL)

Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X.ray and ultrasound findings. Finally, the diagnosis was ...

Posterolateral Bochdalek diaphragmatic hernia in adults Hernia diafragmática posterolateral de Bochdalek en el adulto

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José Maximiliano Garófano-Jerez

2011-09-01

Full Text Available Bochdalek hernias (BHs are produced in the posterolateral area of the diaphragm. They are generally congenital, appearing in childhood, but are also detected in asymptomatic adult patients seeking medical attention for other reasons. Computed tomography (CT or magnetic resonance imaging (MRI is used for the correct diagnosis of the hernia type and for its localization, facilitating its management and the choice of treatment. We describe three cases of Bochdalek hernia, two on the right side and one bilateral, which was larger on the right than left side. All of these hernias contained only omental fat. In one patient, the right kidney was adjacent to the diaphragmatic defect but remained within the abdomen. The patients showed no symptoms and were not surgically treated. Examination by multi-slice CT with the possibility of coronal and sagittal reconstruction should be considered the standard method for diagnosing this entity. MRI in T1 is highly valuable to evaluate fat-containing chest lesions. The incidental finding of BH in asymptomatic adults is increasing, thanks to the wider application of new imaging techniques.Las hernias de Bochdalek se producen a través de la zona posterolateral del diafragma. Generalmente son congénitas y se presentan en la infancia, pero pueden verse también en la edad adulta en pacientes asintomáticos, que consultan por patologías diversas. El uso de tomografía computarizada o resonancia magnética permite el diagnóstico correcto del tipo y localización de la hernia, lo cual facilitará su manejo y la elección del tratamiento. Presentamos 3 casos clínicos, dos tenían una hernia de Bochdalek derecha, y, el otro caso es bilateral, siendo mayor la situada en el lado derecho. En todos nuestros casos, el contenido ha sido únicamente grasa omental. No obstante, en uno de ellos, el riñón derecho se situaba adyacente al defecto diafragmático, pero dentro del abdomen. Debido a la ausencia de sintomatolog

Acute Intrathoracic Gastric Volvulus due to Diaphragmatic Hernia: A Rare Emergency Easily Overlooked

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Hyung Hun Kim

2011-05-01

Full Text Available Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.

[Postnatal diagnosis of gastric volvulus revealing congenital diaphragmatic hernia].

Science.gov (United States)

Aprahamian, A; Nouyrigat, V; Grévent, D; Hervieux, E; Chéron, G

2017-05-01

Postnatally diagnosed congenital diaphragmatic hernias (CDH) are rare and have a better prognosis than those diagnosed prenatally. Postnatal symptoms can be respiratory, digestive, or mixed. Gastric volvulus can reveal CDH. Symptoms are pain, abdominal distension, and/or vomiting. Upper gastrointestinal barium X-ray radiography provides the diagnosis. Prognosis is related to early surgical management in complicated forms with intestinal occlusion or sub-occlusion. We report on an infant who presented with vomiting, which revealed gastric volvulus associated with a CDH. Progression was favorable after surgical treatment. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Transient mega-esophagus in a neonate with congenital diaphragmatic hernia

International Nuclear Information System (INIS)

Makhoul, I.R.; Smolkin, T.; Sujov, P.; Shoshany, G.; Epelman, M.

2001-01-01

Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management. (orig.)

Transient mega-esophagus in a neonate with congenital diaphragmatic hernia

Energy Technology Data Exchange (ETDEWEB)

Makhoul, I.R.; Smolkin, T.; Sujov, P. [Dept. of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa (Israel); Shoshany, G. [Dept. of Pediatric Surgery, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa (Israel); Epelman, M. [Dept. of Radiology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa (Israel)

2001-05-01

Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management. (orig.)

Unusual delayed presentation of diaphragmatic hernia complicated by transverse colon and total small-bowel obstruction after postoperative chemotherapy of esophageal cancer

Directory of Open Access Journals (Sweden)

Sun Y

2017-06-01

Full Text Available Yanlai Sun,1,2,* Lei Yin,2,* Hongfan Xue,2 Haipeng Wang,2 Zengjun Li,2 Jinming Yu3 1Post-doctoral Research Station, Tianjin Medical University, Tianjin, 2Department of Gastrointestinal Cancer Surgery, 3Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, People’s Republic of China *These authors equally contributed to this work Abstract: Diaphragmatic hernia (DH is defined as the passage of abdominal contents into the chest cavity through a defect in the diaphragm. DH occurs after chest or abdominal surgery, and is very rare and sporadically reported in the literature. However, the complications are significant and put the patient at great risk. The aim of the present report was to describe a special case with postesophagectomy diaphragmatic hernia (PDH because of its appearance during chemotherapy and confusion of the symptoms with the side effects of chemotherapy. A high index of suspicion needs to be maintained in clinical practice. Keywords: diaphragmatic hernia, postoperative chemotherapy, esophageal cancer, complications

A late presenting congenital diaphragmatic hernia misdiagnosed as spontaneous pneumothorax

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Chitra Sanjeev Juwarkar

2010-01-01

Full Text Available Congenital diaphragmatic hernia (CDH is described as (1 failure of diaphragmatic closure at development, (2 presence of herniated abdominal contents into chest and (3 pulmonary hypoplasia. Usually, pleural space is drained urgently when there is respiratory distress and radiological appearance of mediastinal shift. We present a case of a 5-month-old baby, diagnosed as tension pneumothorax and treated with chest drain insertion. CDH was the intraoperative diagnosis.

Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results

International Nuclear Information System (INIS)

Abolmaali, Nasreddin; Koch, Arne; Goetzelt, Knut; Vogelberg, Christian; Hahn, Gabriele; Fitze, Guido

2010-01-01

To compare MRI-based functional pulmonary and cardiac measurements in the long-term follow-up of children operated on for left-sided congenital diaphragmatic hernia (CDH) with age- and body size-matched healthy controls. Twelve children who received immediate postnatal surgery for closure of isolated left-sided CDH were included and received basic medical examinations, pulmonary function testing and echocardiography. MRI included measurement of lung volume, ventricular function assessment and velocity-encoded imaging of the pulmonary arteries and was compared with the data for 12 healthy children matched for age and body size. While patients' clinical test results were not suspicious, comparison between the MRI data for patients and those for healthy controls revealed significant differences. In patients, the volumes of the left lungs were increased and the tidal volume was larger on the right side. While the stroke volumes of both ventricles were reduced, heart rate and ejection fraction were increased. Flow, acceleration time and cross-sectional area of the left pulmonary artery were reduced. Functional MRI detected pulmonary and cardiac findings in the late follow-up of CDH children which may be missed by standard clinical methods and might be relevant for decisions regarding late outcome and treatment. (orig.)

Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results

Energy Technology Data Exchange (ETDEWEB)

Abolmaali, Nasreddin; Koch, Arne [Dresden University of Technology, OncoRay - Molecular and Biological Imaging, Medical Faculty Carl Gustav Carus, Dresden (Germany); Goetzelt, Knut; Vogelberg, Christian [University Clinics Carl Gustav Carus, Dresden University of Technology, Clinic and Policlinic for Pediatrics - Pediatric Pulmonology, Dresden (Germany); Hahn, Gabriele [University Clinics Carl Gustav Carus, Dresden University of Technology, Institute and Policlinic for Radiology - Pediatric Radiology, Dresden (Germany); Fitze, Guido [University Clinics Carl Gustav Carus, Dresden University of Technology, Clinic and Policlinic for Pediatric Surgery, Dresden (Germany)

2010-07-15

To compare MRI-based functional pulmonary and cardiac measurements in the long-term follow-up of children operated on for left-sided congenital diaphragmatic hernia (CDH) with age- and body size-matched healthy controls. Twelve children who received immediate postnatal surgery for closure of isolated left-sided CDH were included and received basic medical examinations, pulmonary function testing and echocardiography. MRI included measurement of lung volume, ventricular function assessment and velocity-encoded imaging of the pulmonary arteries and was compared with the data for 12 healthy children matched for age and body size. While patients' clinical test results were not suspicious, comparison between the MRI data for patients and those for healthy controls revealed significant differences. In patients, the volumes of the left lungs were increased and the tidal volume was larger on the right side. While the stroke volumes of both ventricles were reduced, heart rate and ejection fraction were increased. Flow, acceleration time and cross-sectional area of the left pulmonary artery were reduced. Functional MRI detected pulmonary and cardiac findings in the late follow-up of CDH children which may be missed by standard clinical methods and might be relevant for decisions regarding late outcome and treatment. (orig.)

Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results.

Science.gov (United States)

Abolmaali, Nasreddin; Koch, Arne; Götzelt, Knut; Hahn, Gabriele; Fitze, Guido; Vogelberg, Christian

2010-07-01

To compare MRI-based functional pulmonary and cardiac measurements in the long-term follow-up of children operated on for left-sided congenital diaphragmatic hernia (CDH) with age- and body size-matched healthy controls. Twelve children who received immediate postnatal surgery for closure of isolated left-sided CDH were included and received basic medical examinations, pulmonary function testing and echocardiography. MRI included measurement of lung volume, ventricular function assessment and velocity-encoded imaging of the pulmonary arteries and was compared with the data for 12 healthy children matched for age and body size. While patients' clinical test results were not suspicious, comparison between the MRI data for patients and those for healthy controls revealed significant differences. In patients, the volumes of the left lungs were increased and the tidal volume was larger on the right side. While the stroke volumes of both ventricles were reduced, heart rate and ejection fraction were increased. Flow, acceleration time and cross-sectional area of the left pulmonary artery were reduced. Functional MRI detected pulmonary and cardiac findings in the late follow-up of CDH children which may be missed by standard clinical methods and might be relevant for decisions regarding late outcome and treatment.

Imaging of congenital diaphragmatic hernias

International Nuclear Information System (INIS)

Taylor, George A.; Estroff, Judy A.; Atalabi, Omolola M.

2009-01-01

Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients. (orig.)

Imaging of congenital diaphragmatic hernias

Energy Technology Data Exchange (ETDEWEB)

Taylor, George A.; Estroff, Judy A. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); Atalabi, Omolola M. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); The College of Medicine/University College Hospital, Ibadan (Nigeria)

2009-01-15

Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients. (orig.)

Congenital diaphragmatic hernia candidate genes derived from embryonic transcriptomes

DEFF Research Database (Denmark)

Russell, Meaghan K; Longoni, Mauro; Wells, Julie

2012-01-01

Congenital diaphragmatic hernia (CDH) is a common (1 in 3,000 live births) major congenital malformation that results in significant morbidity and mortality. The discovery of CDH loci using standard genetic approaches has been hindered by its genetic heterogeneity. We hypothesized that gene...

Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia.

Science.gov (United States)

Stressig, R; Fimmers, R; Schaible, T; Degenhardt, J; Axt-Fliedner, R; Gembruch, U; Kohl, T

2013-12-01

Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO. © Georg Thieme Verlag KG Stuttgart · New York.

Congenital diaphragmatic hernia with gastrointestinal symptomatology

International Nuclear Information System (INIS)

Siroka, M.; Bilicky, J.; Hernesniemi, B.

2014-01-01

The authors report a case of 6-week-old baby boy with congenital diaphragmatic hernia(CDH). He presented with nonspecific gastrointestinal symptoms. CDH is commonly manifested by nonspecific respiratory problems. The symptoms of CDH in older infants are atypical and misleading. Children may have only gastrointestinal problems even the acute abdomen. In our case, the ultrasound examination of abdomen did not detect the exact cause of vomiting and intolerance of oral intake, but the explanation has brought classic chest X-ray. (author)

Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants.

Science.gov (United States)

Moyer, V; Moya, F; Tibboel, R; Losty, P; Nagaya, M; Lally, K P

2002-01-01

Congenital diaphragmatic hernia, although rare (1 per 2-4,000 births), is associated with high mortality and cost. Opinion regarding the timing of surgical repair has gradually shifted from emergent repair to a policy of stabilization using a variety of ventilatory strategies prior to operation. Whether delayed surgery is beneficial remains controversial. To summarize the available data regarding whether surgical repair in the first 24 hours after birth rather than later than 24 hours of age improves survival to hospital discharge in infants with congenital diaphragmatic hernia who are symptomatic at or immediately after birth. Search of MEDLINE (1966-2002), EMBASE (1978-2002) and the Cochrane databases using the terms "congenital diaphragmatic hernia" and "surg*"; citations search, and contact with experts in the field to locate other published and unpublished studies. Studies were eligible for inclusion if they were randomized or quasi-randomized trials that addressed infants with CDH who were symptomatic at or shortly after birth, comparing early (24 hours) surgical intervention, and evaluated mortality as the primary outcome. Data were collected regarding study methods and outcomes including mortality, need for ECMO and duration of ventilation, both from the study reports and from personal communication with investigators. Analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Two trials met the pre-specified inclusion criteria for this review. Both were small trials (total n<90) and neither showed any significant difference between groups in mortality. Meta-analysis was not performed because of significant clinical heterogeneity between the trials. There is no clear evidence which favors delayed (when stabilized) as compared with immediate (within 24 hours of birth) timing of surgical repair of congenital diaphragmatic hernia, but a substantial advantage to either one cannot be ruled out. A large, multicenter randomized

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

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Abubakar Auwal

2011-01-01

Full Text Available Background: Despite the advances in management, congenital diaphragmatic hernia (CDH has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8% and on the right side in one (17.7%. All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

Congenital Diaphragmatic Hernia: Long-term Risk of Gastroesophageal Reflux Disease

NARCIS (Netherlands)

Peetsold, Marieke G.; Kneepkens, C. M. F. Frank; Heij, Hugo A.; Ijsselstijn, Hanneke; Tibboel, Dick; Gemke, Reinoud J. B. J.

2010-01-01

Objectives: Gastroesophageal reflux disease (GERD) is a well-recognized consequence of congenital diaphragmatic hernia (CDH). Results of studies examining predictive factors for early and late GERD are inconclusive. The aim of this study was to assess the incidence of early ( <2 years) and late GERD

Congenital Diaphragmatic Hernia: Long-term Risk of Gastroesophageal Reflux Disease

NARCIS (Netherlands)

Peetsold, M.G.; Kneepkens, C.M.F.; Heij, H.A.; IJsselstijn, H.; Tibboel, D.; Gemke, R.J.B.J.

2010-01-01

Objectives: Gastroesophageal reflux disease (GERD) is a well-recognized consequence of congenital diaphragmatic hernia (CDH). Results of studies examining predictive factors for early and lateGERDare inconclusive. The aim of this study was to assess the incidence of early (<2 years) and late GERD

Radiographic diagnosis of diaphragmatic hernia: review of 60 cases in dogs and cats.

Science.gov (United States)

Hyun, Changbaig

2004-06-01

Sixty cases of diaphragmatic hernia in dogs and cats were radiologically reviewed and categorized by their characteristic radiographic signs. Any particular predilection for age, sex, or breed was not observed. Liver, stomach and small intestine were more commonly herniated. At least two radiographs, at different angles, were required for a valid diagnosis, because some radiographic signs were not visible in a single radiographic view and more clearly detectable in two radiographic views. In addition to previously reported radiographic signs for diaphragmatic hernia, we found that the location of the stomach axis and the displacement of tracheal and bronchial segments were also useful radiographic signs.

Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors.

Science.gov (United States)

Barbosa, Bruna Maria Lopes; Rodrigues, Agatha S; Carvalho, Mario Henrique Burlacchini; Bittar, Roberto Eduardo; Francisco, Rossana Pulcineli Vieira; Bernardes, Lisandra Stein

2018-01-12

To evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH). A retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice. Eighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%. O/e LHR was the only predictor of prematurity in this sample.

Congenital Diaphragmatic Hernia and Occupational Therapy: A Case Report

Science.gov (United States)

Bates, Angela C.

2011-01-01

This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation…

Surgical repair of a congenital pericardial diaphragmatic hernia

International Nuclear Information System (INIS)

Wright, R.P.; Wright, R.; Scott, R.

1987-01-01

Objective: To describe the surgical repair and pre- and postoperative management of a peritoneopericardial diaphragmatic hernia (PPDH) in a pregnant dog. Case summary: A pregnant dog was presented for vomiting, lethargy, and pale mucous membranes. Pulsus paradoxus was noted on physical examination. The dog was diagnosed with a PPDH via thoracic radiographs, abdominal ultrasound, and a n echocardiogram. The hernia was surgically repaired and the dog received supportive medical care until the puppies were old enough to be delivered via cesarean section. The mother and all puppies survived. New or unique information provided: This is the first report that describes the surgical repair and postoperative management of a PPDH in a pregnant dog

Congenital diaphragmatic hernia: A 4-year experience in a single ...

African Journals Online (AJOL)

Abstract. Background: This study aimed to evaluate congenital diaphragmatic hernia (CDH) patients in our department during a 4-year period. Patients and Methods: A retrospective study of 10 cases of CDH patients managed in the Neonatology and Pediatric Surgery Units of Goztepe Teaching Hospital from 2000 to 2004.

Clinical, echocardiographic, and radiographic findings of peritoneopericardial diaphragmatic hernia in two dogs and a cat

International Nuclear Information System (INIS)

Hay, W.H.; Woodfield, J.A.; Moon, M.A.

1989-01-01

Peritoneopericardial diaphragmatic hernia was diagnosed in 2 dogs and a cat. One dog was referred because of clinical signs of cardiac tamponade and acute decompensation from liver entrapment within the hernia. Surgical correction of the hernia alleviated clinical signs in all 3 animals. Echocardiography was used in combination with radiography to provide a rapid and accurate diagnosis

A systematic review with meta-analysis of the prevalence of gastroesophageal reflux in congenital diaphragmatic hernia pediatric survivors.

Science.gov (United States)

Arcos-Machancoses, J V; Ruiz Hernández, C; Martin de Carpi, J; Pinillos Pisón, S

2018-02-09

performed. This should be considered when proposing follow-up and management protocols for congenital diaphragmatic hernia survivors. © The Author(s) 2018. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Bilious emesis as presenting symptom of congenital diaphragmatic hernia in an 8-month-old

Directory of Open Access Journals (Sweden)

Daphney Clermont

2017-12-01

Full Text Available Although congenital diaphragmatic hernia (CDH primarily presents in either the prenatal or neonatal period, late presentation has a reported incidence of 2.5–25%. This case report describes an 8-month-old-male who presented to the emergency department with dehydration and a 24-h history of bilious emesis. Work-up led to the diagnosis of a left-sided Bochdalek CDH. He subsequently underwent laparoscopic diaphragmatic hernia repair with reduction of near-total length of incarcerated bowel. The patient had an uneventful recovery. Babies born with CDH are typically unstable at birth, and even with repair, the mortality rate remains high. However, in the case of delayed CDH diagnosis where there are no perinatal issues, surgical repair has very high success rates, provided that there are no complications regarding the delay. If there is not a high index of suspicion based on the patient's history and exam, delayed diagnosis and intervention with late CDH presentations can lead to complications which could otherwise be minimized. The purpose of this case report is to raise awareness and contribute to the growing knowledge about delayed CDH presentation among physicians and surgeons to facilitate early diagnosis and care of a morbid yet manageable condition.

Radiological diagnosis of congenital diaphragmatic hernia in 17th century Korean mummy.

Directory of Open Access Journals (Sweden)

Yi-Suk Kim

Full Text Available Congenital diaphragmatic hernia (CDH is a birth defect of the diaphragm resulting in pulmonary sequelae that threaten the lives of infants. In computed tomography (CT images of a 17th century middle-aged male mummy (the Andong mummy, we observed that the abdominal contents had protruded into the right thoracic cavity through the diaphragmatic defect, accompanied by a mediastinal shift to the left. On autopsy, the defect in the right posterolateral aspect of the diaphragm was reconfirmed, as was the herniation of the abdominal organs. The herniated contents included the right lobe of the liver, the pyloric part of the stomach, a part of the greater omentum, and the right colic flexure connecting the superior part of the ascending colon and the right part of the transverse colon. Taking our CT and autopsy results together, this case was diagnosed as the Bochdalek-type CDH. Herein we make the first ever report of a CT-assisted diagnosis of a pre-modern historical case of CDH. Our results show the promising utility of this modality in investigations of mummified human remains archaeologically obtained.

Epidemiology of congenital diaphragmatic hernia in Europe

DEFF Research Database (Denmark)

McGivern, Mark R.; Best, Kate E.; Rankin, Judith

2015-01-01

INTRODUCTION: Published prevalence rates of congenital diaphragmatic hernia (CDH) vary. This study aims to describe the epidemiology of CDH using data from high-quality, population-based registers belonging to the European Surveillance of Congenital Anomalies (EUROCAT). METHODS: Cases of CDH...... for isolated cases (ie, CDH cases that did not occur with any other congenital anomaly). There was significant variation in total and isolated CDH prevalence between registers. The proportion of cases that survived to 1 week was 69.3% (1392 cases) for total CDH cases and 72.7% (1107) for isolated cases...

Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia.

Science.gov (United States)

Merbl, Yael; Kelmer, Efrat; Shipov, Anna; Golani, Yael; Segev, Gilad; Yudelevitch, Sigal; Klainbart, Sigal

2010-08-01

A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, gamma-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration>5 days) pneumothorax when surgery is not an option.

Characteristics of Infants With Congenital Diaphragmatic Hernia Who Need Follow-Up of Pulmonary Hypertension.

Science.gov (United States)

Kraemer, Ulrike S; Leeuwen, Lisette; Krasemann, Thomas B; Wijnen, René M H; Tibboel, Dick; IJsselstijn, Hanneke

2018-02-06

Pulmonary hypertension is one of the main causes of mortality and morbidity in patients with congenital diaphragmatic hernia. Currently, it is unknown whether pulmonary hypertension persists or recurs during the first year of life. Prospective longitudinal follow-up study. Tertiary university hospital. Fifty-two congenital diaphragmatic hernia patients admitted between 2010 and 2014. None. Pulmonary hypertension was measured using echocardiography and electrocardiography at 6 and 12 months old. Characteristics of patients with persistent pulmonary hypertension were compared with those of patients without persistent pulmonary hypertension. At follow-up, pulmonary hypertension persisted in four patients: at 6 months old, in three patients (patients A-C), and at 12 months old, in two patients (patients C and D). Patients with persistent pulmonary hypertension had a longer duration of mechanical ventilation (median 77 d [interquartile range, 49-181 d] vs median 8 d [interquartile range, 5-15 d]; p = 0.002) and hospital stay (median 331 d [interquartile range, 198-407 d) vs median 33 d (interquartile range, 16-59 d]; p = 0.003) than patients without persistent pulmonary hypertension. The proportion of patients with persistent pulmonary hypertension (n = 4) treated with inhaled nitric oxide (100% vs 31%; p = 0.01), sildenafil (100% vs 15%; p = 0.001), and bosentan (100% vs 6%; p pulmonary hypertension (n = 48). At 6 months, all patients with persistent pulmonary hypertension were tube-fed and treated with supplemental oxygen and sildenafil. Less than 10% of congenital diaphragmatic hernia patients had persistent pulmonary hypertension at ages 6 and/or 12 months. Follow-up for pulmonary hypertension should be reserved for congenital diaphragmatic hernia patients with echocardiographic signs of persistent pulmonary hypertension at hospital discharge and/or those treated with medication for pulmonary hypertension at hospital discharge.

Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

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Carolina Melendez Valdez

Full Text Available CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

Malformations associated with congenital diaphragmatic hernia: Impact on survival.

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Bojanić, Katarina; Pritišanac, Ena; Luetić, Tomislav; Vuković, Jurica; Sprung, Juraj; Weingarten, Toby N; Schroeder, Darrell R; Grizelj, Ruža

2015-11-01

Congenital diaphragmatic hernia (CDH) is associated with high mortality. Survival is influenced by the extent of pulmonary hypoplasia and additional congenital defects. The purpose of this study was to assess the association of congenital anomalies and admission capillary carbon dioxide levels (PcCO2), as a measure of extent of pulmonary hypoplasia, on survival in neonates with CDH. This is a retrospective review of neonates with CDH admitted to a tertiary neonatal intensive care unit between 1990 and 2014. Logistic regression was used to assess whether hospital survival was associated with admission PcCO2 or associated anomalies (isolated CDH, CDH with cardiovascular anomalies, and CDH with noncardiac anomalies). The probabilities of survival (POS) score, based on birth weight and 5-min Apgar as defined by the Congenital Diaphragmatic Hernia Study Group were included as a covariate. Of 97 patients, 55 had additional malformations (cardiovascular n=12, noncardiac anomalies n=43). POS was lower in CDH with other anomalies compared to isolated CDH. Survival rate was 61.9%, 53.5% and 41.7% in isolated CDH, CDH with noncardiac anomalies and CDH with cardiovascular anomalies, respectively. After adjusting for POS score the likelihood of survival in CDH groups with additional anomalies was similar to isolated CDH (OR 0.95, 95% CI 0.22-4.15, and 1.10, 0.39-3.08, for CDH with and without cardiovascular anomalies, respectively). After adjusting for POS score, lower PcCO2 levels (OR=1.25 per 5mmHg decrease, P=0.003) were associated with better survival. Neonates with CDH have a high prevalence of congenital malformations. However, after adjusting for POS score the presence of additional anomalies was not associated with survival. The POS score and admission PcCO2 were important prognosticating factors for survival. Copyright © 2015 Elsevier Inc. All rights reserved.

Pulmonary Vascular Defects in Congenital Diaphragmatic Hernia : the quest for early factors and intervention : Pulmonale vasculaire defecten in congenitale hernia diafragmatica : de zoektocht naar vroege factoren en interventie

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D.S. Mous (Daphne)

2017-01-01

markdownabstractCongenital diaphragmatic hernia (CDH) is a severe anomaly characterized by a diaphragmatic defect, lung hypoplasia and pulmonary hypertension. The associated pulmonary abnormalities are responsible for the high morbidity and mortality among patients with this disease. Vasodilator

Quantitative pulmonary perfusion imaging at 3.0 T of 2-year-old children after congenital diaphragmatic hernia repair: initial results

International Nuclear Information System (INIS)

Zoellner, F.G.; Schad, L.R.; Zahn, K.; Schaible, T.; Schoenberg, S.O.; Neff, K.W.

2012-01-01

To investigate whether dynamic contrast-enhanced MR imaging of the lung following congenital diaphragmatic hernia repair is feasible at 3.0 T in 2-year-old children and whether associated lung hypoplasia (reflected in reduced pulmonary microcirculation) can be demonstrated in MRI. Twelve children with a mean age 2.0 ± 0.2 years after hernia repair underwent DCE-MRI at 3.0 T using a time-resolved angiography with stochastic trajectories sequence. Quantification of lung perfusion was performed using a pixel-by-pixel deconvolution approach. Six regions of interest were placed (upper, middle and lower parts of right and left lung) to assess differences in pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) while avoiding the inclusion of larger pulmonary arteries and veins. The difference in PBF and PBV between ipsilateral and contralateral lung was significant (P < 0.5). No significant differences could be detected for the MTT (P = 0.5). DCE-MRI in 2-year-old patients is feasible at 3.0 T. Reduced perfusion in the ipsilateral lung is reflected by significantly lower PBF values compared with the contralateral lung. DCE-MRI of the lung in congenital diaphragmatic hernia can help to characterise lung hypoplasia initially and in the long-term follow-up of children after diaphragmatic repair. (orig.)

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia.

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Thakur, Shruti; Jhobta, Anupam; Sharma, Brij; Chauhan, Arun; Thakur, Charu S

2017-07-01

Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus. Copyright © 2014. Published by Elsevier Taiwan.

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia

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Shruti Thakur

2017-07-01

Full Text Available Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature.

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Anaya-Ayala, Javier E; Naik-Mathuria, Bindi; Olutoye, Oluyinka O

2008-03-01

Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. Nasogastric decompression was unsuccessful. Via a thoracoscopic approach, the large fluid-filled stomach was percutaneously decompressed but could not be reduced. Through a left subcostal incision, a left-sided diaphragmatic defect about 4 x 5 cm was encountered. A large portion of small intestines, ascending and transverse colon, strangulated but viable stomach, and a large spleen herniated through the defect. The contents were reduced, revealing a combined gastric volvulus. Once the diaphragmatic defect was repaired primarily, there was insufficient space in the abdominal cavity to contain all the viscera reduced form the chest. Therefore, we placed an AlloDerm patch on the fascia and closed with a wound V.A.C (Kinetic Concepts Inc, San Antonio, TX). Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case.

THREE PORTS LAPAROSCOPIC REPAIR OF ADULT MORGAGNI HERNIA AND RARE SIMULTANEOUS PRESENTATION OF PARA-ESOPHAGEAL HERNIA WITH MORGAGNI HERNIA

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Salman Assad

2018-05-01

Full Text Available We report two case reports of Morgagni hernia repair. Our first case was on 65 year old white male who presented with abdominal pain in right upper quadrant and right side of chest for last 3 days. He was having 3 episodes of dark appearing vomiting associated with pain. He also had two episodes of hematemesis. Patient had gastric outlet obstruction with severe distension of stomach because of incarcerated small bowel and colon in the right sided anterior diaphragmatic Morgagni hernia. Laparoscopic repair of incarcerated Morgagni hernia under general anesthesia was planned. We report our second case on rare simultaneous presentation of Morgagni Hernia with type 3 Para esophageal hernia. 60 years old female patient presented in clinic with a follow up of chest discomfort which was progressively increasing with shortness of breath and a chronic gastric reflux. Her vitals were within normal limits and had body mass index (BMI= 29.52kg/m2 (overweight category. Previous past medical history included multiple episodes of gastric regurgitation and cardiovascular intervention for coronary stenting. CT scan showed type 3 paraesophageal hernia (gastro esophageal junction with fundus of stomach displaced above diaphragm. The patient had more than 30% of her stomach incarcerated in the chest as a paraesophageal hernia. The gastro esophageal junction was intra-abdominal after lysis of adhesion. Mesh was placed after posterior crural repair, followed by Nissen fundoplication over a 54 French bougie patient also had an incidental finding of a reducible Morgagni hernia through an anterior defect, followed by a repair without mesh. Esophago-gastro-duodenoscopy showed there was no evidence of any air leak with good valve creation on retroflexion through a fundoplication.

CONGENITAL DIAPHRAGMATIC HERNIA IN A TWO-DAY-OLD NEONATE: ANAESTHETIC MANAGEMENT AND CHALLENGES

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Tridip Jyoti

2016-04-01

Full Text Available INTRODUCTION Congenital diaphragmatic hernia in a neonate is a challenging task to any anaesthesiologist. CDH occurs due to an early developmental defect that results in the extrusion of intra-abdominal organs (i.e. stomach, small intestines, spleen, liver into the thoracic cavity. In 85% of the cases it is left sided. This leads to lung hypoplasia, pulmonary hypertension, and pulmonary arteriolar dysregulation/reactivity. Historically, CDH was considered to be a surgical emergency and aggressive hyperventilatory strategies with high peak inspiratory pressures were employed to improve survival. But recent multicentre studies have shown the beneficial effect of conservative low volume ventilation with low inflation pressures and permissive hypercapnia. We present to you the successful management of a two day old neonate with this ventilation strategy.

Extracorporeal Membrane Oxygenation in Premature Infants With Congenital Diaphragmatic Hernia.

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Cuevas Guamán, Milenka; Akinkuotu, Adesola C; Cruz, Stephanie M; Griffiths, Pamela A; Welty, Stephen E; Lee, Timothy C; Olutoye, Oluyinka O

2017-11-14

Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure. We highlight the interdisciplinary nature of modern decision-making. All three neonates had severe congenital diaphragmatic hernia diagnosed prenatally, had normal fetal karyotypes, were born prematurely, and weighed less than 2 kg. All three neonates underwent cervical venoarterial cannulation, stabilization on ECMO, and repair of their congenital diaphragmatic hernia early in their ECMO courses. All three infants had long courses of respiratory support attributable to lung hypoplasia, but there were no short- or long-term complications attributable to ECMO support directly. All three are alive at 2 years of age and were making progress developmentally. In conclusion, with interdisciplinary collaboration and clinical guidelines uniformly implemented, low birth weight infants may benefit from ECMO and should not be denied the therapy arbitrarily based on gestational age or size alone. Further research is essential to determine appropriate patient selection in premature infants.

Detection of gastroesophageal reflux in survivors of congenital diaphragmatic hernia: A radionuclide scintigraphic study in 26 children

International Nuclear Information System (INIS)

Thomas, E.J.; Bharathi Dasan, J.; Chandrasekhar, N.; Tripathi, M.; Kumar, R.; Kumar, A.; Malhotra, A.; Gupta, D.K.; Mitra, D.K.

2002-01-01

Introduction: Anatomical and functional esophageal abnormalities in survivors with CDH are well known. Gastro-esophageal Reflux (GER) is a common cause of long-term morbidity in survivors of congenital diaphragmatic hernia. The incidence of GER in these patients varies from 20-70% using various modalities. Aims: The present retrospective analysis was undertaken to find out the incidence of GER detected by radionuclide scintigraphy in survivors of congenital diaphragmatic hernia. Materials and Methods: Radionuclide scintigraphy for GER detection were performed in 26 survivors of congenital diaphragmatic hernia (17 male and 9 female) with a mean age of 19 months; age range 10 days to 56 months. Seven of the children had symptoms suggestive of GER. Of these 7, 3 had recurrent respiratory tract infection, 2 had regurgitation, 1 had vomiting and 1 had epigastric pain. The remaining 19 children were referred as part of routine follow up. All the children underwent radionuclide scintigraphy with 100-200 micro curie (3.7 -7.4MBq) of Tc99m-Sulphur Colloid. Results: The radionuclide scintigraphy detected GER in 11 out of 26(42.3%) children. Among the 7 symptomatic children, 4 (57%) had positive scintigraphic studies for reflux. Of these 4, 3(75%) had proximal reflux and 1 had distal reflux. Of the 19 asymptomatic patients, 7 (37%) were positive for GER on scintigraphy. Of these 7, 4 (57%) had proximal reflux and 3 (43%) had distal reflux. Conclusions: There is high incidence of GER in survivors of congenital diaphragmatic hernia irrespective of the presence or absence of symptoms suggestive of GER. Scintiscanning being a simple, noninvasive test can be used for initial evaluation of survivors of CDH for GER

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings

International Nuclear Information System (INIS)

Muzzafar, Sofia; Swischuk, Leonard E.; Jadhav, Siddharth P.

2012-01-01

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias. (orig.)

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings

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Muzzafar, Sofia; Swischuk, Leonard E.; Jadhav, Siddharth P. [University of Texas Medical Branch, Department of Pediatric Radiology, Galveston, TX (United States)

2012-03-15

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias. (orig.)

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings.

Science.gov (United States)

Muzzafar, Sofia; Swischuk, Leonard E; Jadhav, Siddharth P

2012-03-01

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias.

Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia

DEFF Research Database (Denmark)

Henneberg, Steen Winther; Jepsen, S; Andersen, P K

1995-01-01

Congenital diaphragmatic hernia (CDH) still has a mortality risk of around 40%. The concomitant pulmonary hypoplasia and the persistent pulmonary hypertension are of major prognostic importance. The use of a selective pulmonary vasodilator may revert this vicious circle that is fatal to many...

Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs.

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Chantawong, P; Komin, K; Banlunara, W; Kalpravidh, M

2013-01-01

To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia. Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months. The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm. A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.

Pulmonary surfactant protein A, B, and C mRNA and protein expression in the nitrofen-induced congenital diaphragmatic hernia rat model

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van Tuyl, Minke; Blommaart, Piet jan E.; Keijzer, Richard; Wert, Susan E.; Ruijter, Jan M.; Lamers, Wouter H.; Tibboel, Dick

2003-01-01

Neonates with congenital diaphragmatic hernia (CDH) suffer from a diaphragmatic defect, lung hypoplasia, and pulmonary hypertension, with poor lung function forming the major clinical challenge. Despite prenatal diagnosis and advanced postnatal treatment strategies, the mortality rate of CDH is

Hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

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Michael Linton

2016-03-01

Full Text Available Case summary A 14-year-old, female neutered domestic shorthair presented for dyspnoea. Thoracic ultrasonography and radiography showed that a heterogeneous mass was present within the pericardial sac, and the mass continued caudally with the mesenteric fat. On CT, the outline of the diaphragm was not continuous and there was an obvious defect with diaphragmatic thickening present at the mid-level of the liver. A pleural effusion and a small-volume pericardial effusion were also present. A ventral midline coeliotomy and median sternotomy revealed a 5 × 6 × 7 cm firm, irregular, tan-coloured soft tissue mass within the pericardial sac attached to both the diaphragmatic defect and liver. The mass was carefully dissected away from the heart and the diaphragmatic defect was repaired with primary closure. Postoperatively, the cat had a persistent pneumothorax that required continuous pleural suction for 41 h. The cat died 44 h postoperatively. Histopathology and immunohistochemistry confirmed the mass to be a hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia (PPDH. Relevance and novel information This is the first reported case of metaplastic transformation of liver into a sarcoma in a cat with PPDH. In addition, hepatic fibrosarcoma is a rarely reported location for fibrosarcoma in this species.

Acute gastric volvulus and congenital diaphragmatic hernia, case report and review

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Laura Pérez-Egido

2015-01-01

Full Text Available Congenital diaphragmatic hernia (CDH is the result of the incomplete fusion and closure of the pleuroperitoneal canal during the fetal development. CDH is usually diagnosed prenatally but, if undiagnosed, the clinical presentation ranges from asymptomatic children to serious respiratory or gastrointestinal symptoms. Acute gastric volvulus associated with CDH is a rare surgical emergency in children. We report two cases of acute gastric volvulus associated with CDH and review the literature.

Mesentro-axial gastric volvulus in a morgagni diaphragmatic hernia in an old female

International Nuclear Information System (INIS)

Fansur, M.; Atiq, S.

2011-01-01

A Morgagni diaphragmatic hernia is a rare congenital anteromedial defect in adults (5%). Symptoms of visceral herniation are attributable to the organs involved. Imaging is the mainstay of diagnosis either in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms, ultimately requiring surgical intervention because of the risk of incarceration. We present a rare case of 80 years old female with vague upper abdominal pain and recurrent vomiting. An anteromedial parasternal defect was established on conventional as well as on cross-sectional imaging in right hemi diaphragm through which the upper abdominal contents were protruding in the right hemi thorax, all enclosed in a peritoneal sac. The herniation resulted in mesentro-axial gastric volvulus. Due to age and anaesthesia risk, patient was conservatively managed. (author)

Incarcerated Diaphragmatic Hernia with Bowel Perforation Presenting as a Tension Pneumothorax

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Ryan P. Offman

2014-03-01

Full Text Available We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she present with cardiovascular collapse. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy. [West J Emerg Med. 2014;15(2:142-144.

Medical image of the week: Bochdalek hernia

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Omar M

2016-06-01

Full Text Available No abstract available. Article truncated at 150 words. A 61 year-old man presented for an evaluation of a nonproductive cough. He has a history of well-controlled asthma, allergic rhinitis and nasal polyposis, hypertension, gastro-esophageal reflux and obstructive sleep apnea. The ACE inhibitor used to treat hypertension was discontinued. The physical exam was unremarkable. Pulmonary function testing was normal. A PA and lateral chest radiograph was performed and revealed an abnormal contour of the left hemidiaphragm with a large lobulated opacity (Figure 1- blue arrows. Computed chest tomography revealed the lobulated opacity in the left lower lobe contained fat and was consistent with a Bochdalek hernia (Figure 2. Congenital diaphragmatic hernia is a major malformation in newborns and in the perinatal period. The diagnosis of congenital diaphragmatic hernia in adults is rare. There are three types of congenital diaphragmatic hernias: posterolateral (Bochdalek diaphragmatic hernia, subcostosternal (Morgagni hernia and esophageal hiatal hernia. The Bochdalek diaphragmatic hernia is the result of ...

[A case of strangulated congenital diaphragmatic hernia with necrosis and rupture of the colon and herniation into a left hemithorax in an adult (author's transl)].

Science.gov (United States)

Sarris, M; Georgoulis, J; Gatos, M; Dariotis, A

This is a case report of a successful repair of congenital diaphragmatic hernia in a 48 years old male that contained the transverse colon which was strangulated and ruptured in the left thoracic cavity. It was approached in two stages. First through a laparotomy the proximal part of the transverse colon was divided. The side going to the hernial sac was sutured and the proximal stump was anastomosed to the descending colon. In a second stage, two days later, through a felt thoracotomy the strangulated and ruptured colon was resected and the distal stump of the transverse colon was sutured and the hernia repaired.

Right diaphragmatic rupture and hepatic hernia: an indirect sign on computed tomography

International Nuclear Information System (INIS)

Sadeghi, N.; Nicaise, N.; Struyven, J.; Gansbeke, D. van; DeBacker, D.

1999-01-01

We report a case of blunt traumatic right diaphragm rupture with hepatic hernia. The diagnosis was first suggested by an abnormal hepatic location depicted on axial CT. This finding can be considered as a potentially new indirect sign of right diaphragm rupture in patients with blunt trauma. The diagnosis was then confirmed by reformatted CT and MR images. (orig.)

A case of right-sided Bochdalek hernia incidentally diagnosed in a gastric cancer patient.

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Kikuchi, Satoru; Nishizaki, Masahiko; Kuroda, Shinji; Kagawa, Shunsuke; Fujiwara, Toshiyoshi

2016-06-01

Bochdalek hernia (BH) is generally congenital, presenting with respiratory distress. However, this pathology is rarely detected in adults. Some adult cases of BH present with symptoms attributed to the hernia, but incidental detection of BH is increasing among asymptomatic adults due to advances in imaging modalities. This report presents the management of incidental BH patients detected in the preoperative period of gastric cancer. An asymptomatic 76-year-old woman was diagnosed with advanced gastric cancer during follow-up after radiotherapy for uterine cervical cancer. Computed tomography (CT) was performed to exclude metastatic gastric cancer, incidentally detecting right-sided BH. We planned distal gastrectomy with lymph node dissection for gastric cancer and simultaneous repair of BH using a laparoscopic approach. We performed laparoscopic gastrectomy for gastric cancer and investigated the right-sided BH to assess whether repair during surgery was warranted. Herniation of the liver into the right hemithorax was observed, but was followed-up without surgical repair because the right hepatic lobe was adherent to the remnant right anterior hemidiaphragm and covered the huge defect in the right hemidiaphragm. No intra- or postoperative pneumothorax was observed during pneumoperitoneum. Regardless of symptoms, repair of adult BH is generally recommended to prevent visceral incarceration. However, BH in asymptomatic adults appears to be more common than previously reported in the literature. Surgeons need to consider the management of incidental BH encountered during thoracic or abdominal surgery.

Late-presenting congenital diaphragmatic hernia

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Raashid Hamid

2014-01-01

Full Text Available Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients to non-specific gastrointestinal complaints (5 patients. In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years. Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

Formed Due to Traumatic Diaphragmatic Injury, A Case of Gastric Perforation

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Ceren Sen Tanrikulu

2014-03-01

Full Text Available Diaphragmatic hernia may be congenital or traumatic in origin. Diaphragmatic hernias are more common in adult and occur as a result of penetrating injuries are more common than from blunt injuries. Traumatic diaphragmatic hernia may manifest immediately or without any findings that several months/years after the incident. Early diagnosis is difficult, and it is usually made intraoperatively. Frequently during the early phase of traumatic diaphragmatic hernias, abdominal organ injury can be seen, such as stomach, colon and liver. In this study, we presented a case with acute gastric strangulation and perforation in the diaphragmatic injury occurred as a result of penetrating thoracic trauma.

Management of Postoperative Pulmonary Hypertension by Inhaled Nitric Oxide in a Newborn with Congenital Diaphragmatic Hernia

International Nuclear Information System (INIS)

Fettah, N. D.; Dilli, D.; Beken, S.; Zenciroglu, A.; Okumus, N.; Cavusoglu, H.; Ozgur, S.

2014-01-01

Postero-lateral congenital diaphragmatic hernia (CDH) is a life threatening anomaly characterized by diaphragmatic defect and intrathoracic herniation of abdominal viscera. In patients with CDH, the lungs are hypoplastic and persistent pulmonary hypertension develops in most cases. Although, inhaled nitric oxide (iNO) results in a reduction in pulmonary hypertension with improvement in oxygenation, its benefit in the patients with CDH remains controversial. In this report, the authors present successful management of postoperative pulmonary hypertension by iNO in a newborn with CDH. (author)

Right diaphragmatic rupture and hepatic hernia: an indirect sign on computed tomography

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Sadeghi, N.; Nicaise, N.; Struyven, J.; Gansbeke, D. van [Department of Radiology, Hopital Erasme, Brussel (Belgium); DeBacker, D. [Intensive Care Unit, Hopital Erasme, Brussels (Belgium)

1999-06-01

We report a case of blunt traumatic right diaphragm rupture with hepatic hernia. The diagnosis was first suggested by an abnormal hepatic location depicted on axial CT. This finding can be considered as a potentially new indirect sign of right diaphragm rupture in patients with blunt trauma. The diagnosis was then confirmed by reformatted CT and MR images. (orig.) With 1 fig., 16 refs.

Hiatal hernia and diaphragmatic eventration in a leopard (Panthera pardus).

Science.gov (United States)

Kearns, K S; Jones, M P; Bright, R M; Toal, R; DeNovo, R; Orosz, S

2000-09-01

A 1-yr-old male leopard (Panthera pardus) presented for intermittent anorexia, emaciation, and generalized muscle wasting. Plain radiographs, ultrasonography, and esophageal endoscopy led to a diagnosis of diaphragmatic eventration with probable concurrent hiatal hernia. An exploratory laparotomy confirmed both diagnoses, and surgical repair and stabilization were performed. After surgery, the leopard was maintained on small liquid meals for 4 days, with a gradual return to normal diet over 2 wk. By 4 wk after surgery, the leopard was eating well and gaining weight, and it showed no recurrence of clinical signs for 2 yr subsequently, becoming mildly obese.

Fascicular Phrenic Nerve Neurotization for Restoring Physiological Motion in a Congenital Diaphragmatic Hernia Reconstruction With a Reverse Innervated Latissimus Dorsi Muscle Flap.

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Horta, Ricardo; Henriques-Coelho, Tiago; Costa, Joana; Estevão-Costa, José; Monteiro, Diana; Dias, Mariana; Braga, José; Silva, Alvaro; Azevedo, Inês; Amarante, José Manuel

2015-08-01

Congenital diaphragmatic hernia is a severe developmental anomaly characterized by the malformation of the diaphragm. An innervated reversed latissimus dorsi flap reconstruction for recurrent congenital diaphragmatic hernia has been described as an alternative to prosthetic patch repair to achieve pleuroperitoneal separation. However, there is very little supporting scientific data; therefore, there is no real basic understanding of the condition of the phrenic nerve in the absence of diaphragmatic muscle or even the neurotization options for restoring neodiaphragmatic muscle motion. We have reviewed the literature regarding phrenic nerve anatomy and neurotization options, and to our knowledge, this is the first time that the application of a fascicular repair is being described where the continuity of one remaining fascicle of the diaphragm has been preserved close to the phrenic nerve distal division. The procedure was undertaken in a 3 year-old boy, with the diagnosis of congenital large posteromedial diaphragmatic hernia and dependence of mechanical ventilation in consequence of severe bronchopulmonary dysplasia.The phrenic nerve divides itself into several terminal branches, usually three, at the diaphragm level, or just above it. This allows the selective coaptation of separate fascicular branches. In the case described, videofluoroscopy evaluation showed no evidence of paradoxical neodiaphragmatic motion, with synchronous contraction movements and intact pleura-peritoneal separation. The child is now asymptomatic and shows improvement of his previous restrictive pulmonary disease.We believe that fascicular repair can achieve some reinnervation of the flap without jeopardizing the potential of diaphragmatic function by contraction of reminiscent native diaphragm.

Radiographic diagnosis of diaphragmatic hernia: review of 60 cases in dogs and cats

International Nuclear Information System (INIS)

Hyun, C.B.

2004-01-01

Sixty cases of diaphragmatic hernia in dogs and cats were radiologically reviewed and categorized by their characteristic radiographic signs. Any particular predilection for age, sex, or breed was not observed. Liver, stomach and small intestine were more commonly herniated. At least two radiographs, at different angles, were required for a valid diagnosis, because some radiographic signs were not visible in a single radiographic view and more clearly detectable in two radiographic views

Hernia diafragmática paraesternal de Morgagni-Larrey en adulto Morgagni-Larrey parasternal diaphragmatic hernia in the adult

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L. A. Arráez-Aybar

2009-05-01

Full Text Available Con una prevalencia de 0,3-0,5/1.000 nacimientos, la hernia diafragmática congénita (HDC sigue siendo una anomalía grave, no bien entendida, alta mortalidad y tratamiento no siempre efectivo. En España se ha informado de una frecuencia del 0,69%oo con una tendencia decreciente en el periodo 1980-2006 del 0,10%oo por año. No obstante, hasta un 5% se diagnostican en adultos durante la realización de un reconocimiento por otra causa. Presentamos un cuadro de vómitos de tres meses de evolución en una mujer de 74 años por hernia diafragmática paraesternal de Morgagni-Larrey (retrocondroesternal, retrocostoxifoidea, retroesternal, subcostal, subesternal o subcostoesternal, que nos ha permitido realizar una actualización de esta patología en adultos y de la morfogénesis del diafragma toracoabdominal. Es en la embriología del diafragma donde encontramos explicación de algunas de sus alteraciones morfológicas y características clínicas, si bien persisten aspectos confusos de la misma. También analizamos el grado de controversia que persiste en algunos aspectos de su tratamiento quirúrgico (vías de acceso, uso o no de mallas y reducción o no del saco herniario. Por lo general priman las técnicas mínimamente invasivas. Consideramos el abordaje laparoscópico como de elección en pacientes adultos con hernia paraesternal candidatos a la cirugía.With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%oo with a yearly decreasing trend of 0.10%oo during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons. We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal

Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair.

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Fox, Catherine; Stewart, Michael; King, Sebastian K; Patel, Neil

2016-12-01

Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012). A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive. Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology. Level IV case series with no comparison group. Copyright © 2016 Elsevier Inc. All rights reserved.

Neonatal diabetes mellitus and congenital diaphragmatic hernia: coincidence or concurrent etiology?

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Topiol Emmanuelle S

2012-07-01

Full Text Available Abstract Neonatal diabetes mellitus (NDM is a rare metabolic disorder, affecting approximately 1 in 500,000 live births. The management of NDM is challenging, as the benefits of controlling hyperglycemia must be balanced with the risks of iatrogenic hypoglycemia. NDM occurs in both permanent and transient forms, which have been genetically and phenotypically well characterized. Herein, we present the previously unreported combination of transient NDM (TNDM and congenital diaphragmatic hernia (CDH. In addition to reviewing the management and genetics of NDM we discuss the potential for overlapping genetic or embryologic abnormalities to explain the concurrence of CDH and NDM.

Chylothorax associated with a congenital peritoneopericardial diaphragmatic hernia in a dog.

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Schmiedt, Chad Weber; Washabaugh, Kate F; Rao, Deepa B; Stepien, Rebecca L

2009-01-01

A 2-year-old dog was presented with a 3-month history of increasing respiratory effort and rate, inappetence, and lethargy. Chest radiographs demonstrated significant pleural effusion, which was consistent with chyle on biochemical and cytological evaluations. Further diagnostic evaluation, including a thoracic computed tomographic scan, revealed a peritoneopericardial diaphragmatic hernia (PPDH) resulting in a large, fat-attenuating mass within the pericardium. The dog was taken to surgery for repair of the PPDH, pericardectomy, and cisterna chyli ablation. Rapid and permanent resolution of the chylothorax occurred postoperatively. This is the first reported case of chylothorax secondary to PPDH.

Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study

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Angélica de Fátima de Assunção Braga

Full Text Available Abstract Background and objectives: The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO. Method: Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records. Results: FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8 ± 6.5; weight 68.64 ± 12.26; ASA I and II. Obstetric: IG 26.1 ± 1.10 weeks (in FETO; 32.86 ± 1.58 (reversal of occlusion; 34.96 ± 2.78 (delivery. Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g in the occlusion and delivery times, respectively (1045.82 ± 222.2 and 2294 ± 553; RPC in FETO and reversal of occlusion: 0.7 ± 0.15 and 1.32 ± 0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO and indomethacin (rectal. Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10 mg and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal anesthesia: fentanyl 10-20 mg.kg-1 and pancuronium 0.1-0.2 mg.kg-1 (IM. Neonatal survival rate was 60.7%. Conclusion: FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

Congenital diaphragmatic hernia interval on chromosome 8p23.1 characterized by genetics and protein interaction networks

DEFF Research Database (Denmark)

Longoni, Mauro; Hansen, Kasper Lage; Russell, Meaghan K.

2012-01-01

Chromosome 8p23.1 is a common hotspot associated with major congenital malformations, including congenital diaphragmatic hernia (CDH) and cardiac defects. We present findings from high‐resolution arrays in patients who carry a loss (n = 18) or a gain (n = 1) of sub‐band 8p23.1. We confirm a region...

Interval between injection of contrast material and positive contrast cheliography affects accurate diagnosis of diaphragmatic hernia

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Ismail A. Sen

2015-01-01

Full Text Available The aim of this study was to evaluate the clinical, surgical and diagnostic imaging findings in 11 cats and 3 dogs with suspected acute and chronic traumatic diaphragmatic hernia, and to compare the results of positive contrast cheliography (peritoneography taken immediately and 5 min after the injection of contrast material. Thoracic and abdominal radiography, ultrasonography, and positive contrast cheliography of all animals were performed. Eight cases were considered as acute and six cases were considered chronic. The contrast images taken immediately after the injection of contrast material revealed the contrast material in the thoracic cavity in 8/8 acute trauma patients, but in none of the chronic cases. In 5/6 of these cases contrast material was seen in the thoracal cavity only in additional images taken after 5 min. One patient was diagnosed with FIP and excluded from the study. Twelve cases had complete resolution and one animal died during the early postoperative period. Our results suggest that positive contrast cheliography performed immediately after the injection of contrast material may not reveal chronic cases of diaphragmatic hernia and a second imaging (or imaging after 5 min is indicated in order not to overlook chronic cases.

Evaluation of lung function changes before and after surfactant application during artificial ventilation in newborn rats with congenital diaphragmatic hernia

NARCIS (Netherlands)

E.C. Scheffers; H. IJsselstijn (Hanneke); R. Tenbrinck (Robert); B.F. Lachmann (Burkhard); J.C. de Jongste (Johan); J.C. Molenaar; D. Tibboel (Dick)

1994-01-01

textabstractPatients with congenital diaphragmatic hernia (CDH) have unilateral or bilateral hypoplasia of the lungs including delayed maturation of the terminal air sacs. Because these lungs are highly susceptible to barotrauma and oxygen toxicity, even in full-term newborns, continued research

Spatial and temporal expression of glucocorticoid, retinoid, and thyroid hormone receptors is not altered in lungs of congenital diaphragmatic hernia

NARCIS (Netherlands)

Rajatapiti, Prapapan; Keijzer, Richard; Blommaart, Pietjan E.; Lamers, Wouter H.; de Krijger, Ronald R.; Visser, Theo J.; Tibboel, Dick; Rottier, Robbert

2006-01-01

The degree of associated pulmonary hypoplasia and persistent pulmonary hypertension are major determination factors for survival in congenital diaphragmatic hernia (CDH) patients. Glucocorticoids, thyroid hormone, and vitamin A have been shown to be involved in human lung development. To determine

Prematurity and fetal lung response after tracheal occlusion in fetuses with severe congenital diaphragmatic hernia.

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Sananes, Nicolas; Rodo, Carlota; Peiro, Jose Luis; Britto, Ingrid Schwach Werneck; Sangi-Haghpeykar, Haleh; Favre, Romain; Joal, Arnaud; Gaudineau, Adrien; Silva, Marcos Marques da; Tannuri, Uenis; Zugaib, Marcelo; Carreras, Elena; Ruano, Rodrigo

2016-09-01

To evaluate the independent association of fetal pulmonary response and prematurity to postnatal outcomes after fetal tracheal occlusion for congenital diaphragmatic hernia. Fetal pulmonary response, prematurity (prematurity (prematurity was not statistically associated with mortality after controlling for fetal pulmonary response (aOR 0.52, 95% CI 0.12-2.30, p=0.367). Fetal pulmonary response after FETO is the most important factor associated with survival, independently from the gestational age at delivery.

[Congenital diaphragmatic hernia: respiratory and vascular outcomes].

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Pennaforte, T; Rakza, T; Sfeir, R; Aubry, E; Bonnevalle, M; Fayoux, P; Deschildre, A; Thumerelle, C; de Lagausie, P; Benachi, A; Storme, L

2012-02-01

Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly associated with a variable degree of pulmonary hypoplasia (PH) and persistent pulmonary hypertension (PPH). Despite remarkable advances in neonatal resuscitation and intensive care, and new postnatal treatment strategies, the rates of mortality and morbidity in the newborn with CDH remain high as the result of severe respiratory failure secondary to PH and PPH. Later, lung function assessments show obstructive and restrictive impairments due to altered lung structure and lung damage due to prolonged ventilatory support. The long-term consequences of pulmonary hypertension are unknown. Other problems include chronic pulmonary aspiration caused by gastro-oesophageal reflux and respiratory manifestations of allergy such as asthma or rhinitis. Finally, failure to thrive may be caused by increased caloric requirements due to pulmonary morbidity. Follow-up studies that systematically assess long-term sequelae are needed. Based on such studies, a more focused approach for routine multidisciplinary follow-up programs could be established. It is the goal of the French Collaborative Network to promote exchange of knowledge, future research and development of treatment protocols. Copyright © 2012. Published by Elsevier Masson SAS.

Prenatal diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center Diagnóstico pré-natal e evolução perinatal de 38 casos de hérnia diafragmática congênita: 8 anos de experiência de um serviço terciário brasileiro

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Rodrigo Ruano

2006-06-01

Full Text Available PURPOSE: To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks.Thirty (79% cases had a left diaphragmatic defect and 8 (21% had a right lesion. Associated structural malformations were observed in 21 (55% cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45% cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.OBJETIVO: Avaliar os resultados neonatais dos

Imaging of diaphragmatic rupture after trauma

International Nuclear Information System (INIS)

Eren, S.; Kantarci, M.; Okur, A.

2006-01-01

Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented

Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

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H. Hoffmann

2010-01-01

Full Text Available Blunt traumatic diaphragmatic rupture (BTDR is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

Preoperative cardiorespiratory trends in infants with congenital diaphragmatic hernia.

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Moffitt, S T; Schulze, K F; Sahni, R; Wung, J T; Myers, M M; Stolar, C J

1995-04-01

The objective of this study was to determine the cardiovascular and pulmonary adaptations of infants with congenital diaphragmatic hernia (CDH) from birth until delayed surgery through the use of continuous monitoring. Continuous cardiovascular (HR, heart rate variability [HR-SD], BP, blood pressure variability [BP-SD], and oxygen saturation) and ventilatory (minute volume, airway pressure, and effective compliance) measurements were made on-line, using a computerized whole-body plethysmograph-incubator (Vital-trends, VT1000), in nine ventilated infants with CDH. Data collection commenced at birth and continued until surgery. Minute mean values for each variable were recorded. Hourly means were computed from the minute means, averaged across infants each hour over the first 50 hours of life, and regressed against postnatal age. Results showed a significant increase in BP (P newborn infants. Deviation from these idealized patterns may identify an infant who is not responding satisfactorily to the given therapy and who may require alternative treatment modalities.

Evaluation of diaphragmatic motion in normal and diaphragmatic paralyzed dogs using M-mode ultrasonography.

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Choi, Mihyun; Lee, Namsoon; Kim, Ahyoung; Keh, Seoyeon; Lee, Jinsoo; Kim, Hyunwook; Choi, Mincheol

2014-01-01

Diagnosis of unilateral diaphragmatic paralysis in dogs is currently based on fluoroscopic detection of unequal movement between the crura. Bilateral paralysis may be more difficult to confirm with fluoroscopy because diaphragmatic movement is sometimes produced by compensatory abdominal muscle contractions. The purpose of this study was to develop a new method to evaluate diaphragmatic movement using M-mode ultrasonography and to describe findings for normal and diaphragmatic paralyzed dogs. Fifty-five clinically normal dogs and two dogs with diaphragmatic paralysis were recruited. Thoracic radiographs were acquired for all dogs and fluoroscopy studies were also acquired for clinically affected dogs. Two observers independently measured diaphragmatic direction of motion and amplitude of excursion using M-mode ultrasonography for dogs meeting study inclusion criteria. Eight of the clinically normal dogs were excluded due to abnormal thoracic radiographic findings. For the remaining normal dogs, the lower limit values of diaphragmatic excursion were 2.85-2.98 mm during normal breathing. One dog with bilateral diaphragmatic paralysis showed paradoxical movement of both crura at the end of inspiration. One dog with unilateral diaphragmatic paralysis had diaphragmatic excursion values of 2.00 ± 0.42 mm on the left side and 4.05 ± 1.48 mm on the right side. The difference between left and right diaphragmatic excursion values was 55%. Findings indicated that M-mode ultrasonography is a relatively simple and objective method for measuring diaphragmatic movement in dogs. Future studies are needed in a larger number of dogs with diaphragmatic paralysis to determine the diagnostic sensitivity of this promising new technique. © 2013 American College of Veterinary Radiology.

Occult diaphragmatic injuries caused by stab wounds.

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Leppäniemi, Ari; Haapiainen, Reijo

2003-10-01

Missed diaphragmatic perforation caused by penetrating trauma can lead to subsequent strangulation of a hollow viscus, which has prompted the use of invasive diagnostic procedures to exclude occult diaphragmatic injuries in asymptomatic, high-risk patients. The objective of this study was to determine the incidence of occult diaphragmatic injuries caused by stab wounds of the lower chest and upper abdomen, and to examine the natural history and consequences of missed diaphragmatic injuries. On the basis of patient data from two previous randomized studies from our institution, a retrospective analysis was performed on 97 patients treated for anterior stab wounds located between the nipple line, the umbilical level, and the posterior axillary lines not having indications for immediate surgical exploration. The patients were divided into two groups on the basis of their initial randomized management (open or laparoscopic exploration vs. expectant observation). In the exploration group (n = 47), four diaphragmatic injuries (9%) were detected (three left-sided and one right-sided). Excluding patients with associated injuries requiring surgical repair, the incidence of occult diaphragmatic injuries was 3 of 43 (7%). In the observation group (n = 50), there were two patients (4%) with delayed presentation of missed left-sided diaphragmatic injury 2 and 23 months later, respectively. Both injuries resulted from stab wounds of the left flank and presented with herniation of the stomach or small bowel and colon. The overall incidence of occult diaphragmatic injuries in left-sided thoracoabdominal stab wounds was 4 of 24 (17%), and was much lower after stab wounds of left epigastrium (0%), right lower chest (0%), and right epigastrium (4%). In asymptomatic patients with anterior or flank stab wounds of the lower chest or upper abdominal area, the risk of an occult diaphragmatic injury is approximately 7% which, if undetected, is associated with a high risk of subsequent

Peritoneopericardial diaphragmatic hernia: a retrospective study of 31 cats and eight dogs.

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Banz, Angela C; Gottfried, Sharon D

2010-01-01

The records of 31 cats and eight dogs undergoing surgical correction of peritoneopericardial diaphragmatic hernia (PPDH) from 2000 through 2007 were reviewed. Weimaraners and long-haired cats of varying breeds, particularly Maine Coon cats, appear to be at higher risk of PPDH. Presenting complaints were most commonly related to the respiratory and gastrointestinal tracts in both dogs and cats, although respiratory signs were more prevalent in cats, and gastrointestinal signs were more common in dogs. The most common herniated organs were liver, gallbladder, and small intestine. Mortality associated with surgical repair of PPDH in cats and dogs was low in the first 2 weeks postoperatively, and prognosis for return to normal function was excellent. Peri-and postoperative complications were typically minor and self-limiting.

Congenital diaphragmatic hernia with gastric volvulus

OpenAIRE

Jain, Prashant; Sanghavi, Beejal; Sanghani, Hemanshi; Parelkar, S. V.; Borwankar, S. S.

2007-01-01

Gastric volvulus is a surgical emergency presenting in various forms. Association with diaphragmatic defect is well known. Here we describe three cases of gastric volvulus associated with diaphragmatic defect having varied presentations and their management. A rare case of gastric volvulus with complete gangrene of the stomach is also reported. Three types of gastric volvulus have been described depending on the rotation axis: organoaxial, mesentericoaxial and combination of both types. Opera...

Surgical management of the newborn with congenital diaphragmatic hernia.

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Tsao, Kuojen; Lally, Kevin P

2011-01-01

Despite advances in the surgical treatment and medical management over the last 20 years, neonates with congenital diaphragmatic hernia (CDH) remain one of the most challenging patient groups for all clinicians. Treatment strategies have shifted from emergent surgical repair and maximum ventilatory support to delayed repair and preoperative hemodynamic stabilization with lung-sparing ventilation strategies and extracorporeal membrane oxygenation. Subsequently, overall survival has improved to as high as 80% in some centers. However, specific treatment criteria are vague and highly variable amongst centers. This lack of consensus of these treatment modalities remains elusive due to the heterogeneity in disease severity as well as heterogeneity in patient care amongst centers. As a result of the rare incidence of disease and limited experience of individual centers, the evidence for CDH is typically reported as a homogenous disease largely supported by case series and networked-based studies. To better evaluate the data and compare treatment strategies, a classification and stratification of disease and centers is needed. Copyright © 2010 S. Karger AG, Basel.

Congenital pleuroperitoneal hernia presenting as gastrothorax in five cavalier King Charles spaniel dogs.

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Rossanese, M; Pivetta, M; Pereira, N; Burrow, R

2018-04-30

Five cavalier King Charles spaniels were examined for acute onset of respiratory distress. Thoracic radiographs demonstrated diaphragmatic hernia and tension gastrothorax, visible as a distended stomach occupying the left caudal thoracic cavity. Exploratory midline coeliotomy confirmed congenital pleuroperitoneal diaphragmatic hernia with herniation and dilatation of the stomach. The hernia configuration was consistent in all cases, with a defect affecting the left diaphragmatic crus. Congenital pleuroperitoneal diaphragmatic hernia is a rare condition caused by a defect in the dorsolateral diaphragm. Defects of the left crus of the diaphragm could result in the herniation of the stomach into the thoracic cavity with possible subsequent tension gastrothorax. Cavalier King Charles spaniels may have a predisposition to this condition. Tension gastrothorax is an acute life-threatening consequence of gastric herniation through a diaphragmatic defect that must be promptly recognised and surgically treated. © 2018 British Small Animal Veterinary Association.

Imaging modalities used to confirm diaphragmatic hernia in small animals

International Nuclear Information System (INIS)

Williams, J.; Leveille, R.; Myer, C.W.

1998-01-01

When a patient is presented for treatment following a traumatic accident such as being hit by a car, thoracic radiographs are usually an integral part of the overall diagnostic evaluation. Diagnosis at diaphragmatic hernia (DH) is often challenging in small animals. The thorax may contain substantial fluid, thereby masking the presence of cranially displaced abdominal soft tissues (e.g., liver or spleen). The most common cause of decreased radiographic visualization of the diaphragm on survey radiographs is pleural fluid; however, the second most common cause is DH. Obviously, if a gas-filledviscus is identified within the thoracic cavity on survey radiographs, the diagnosis of DH is straightforward and relatively routine. If, however, there is substantial pleural effusion and the herniated structure is a soft tissue parenchymal organ (e.g., liver or spleen), the diagnosis is less clearly defined on survey radiographs. This review discusses the various imaging modalities (survey, positional, and contrast-enhanced radiographs and ultrasonography) that can be used in the diagnosis or confirmation of DH

Mutations in STRA6 cause a broad spectrum of malformations including anophthalmia, congenital heart defects, diaphragmatic hernia, alveolar capillary dysplasia, lung hypoplasia, and mental retardation

NARCIS (Netherlands)

Pasutto, Francesca; Sticht, Heinrich; Hammersen, Gerhard; Gillessen-Kaesbach, Gabriele; Fitzpatrick, David R.; Nuernberg, Gudrun; Brasch, Frank; Schirmer-Zimmermann, Heidemarie; Tolmie, John L.; Chitayat, David; Houge, Gunnar; Fernandez-Martinez, Lorena; Keating, Sarah; Mortier, Geert; Hennekam, Raoul C. M.; von der Wense, Axel; Slavotinek, Anne; Meinecke, Peter; Bitoun, Pierre; Becker, Christian; Nuernberg, Peter; Reis, Andre; Rauch, Anita

2007-01-01

We observed two unrelated consanguineous families with malformation syndromes sharing anophthalmia and distinct eyebrows as common signs, but differing for alveolar capillary dysplasia or complex congenital heart defect in one and diaphragmatic hernia in the other family. Homozygosity mapping

Morgagni's Hernia

International Nuclear Information System (INIS)

Khalid, M.M.

2004-01-01

Congenital diaphragmatic hernias, including Morgagni's hernia, usually present in early childhood and are treated by surgical repair. This case report is about an unusual Morgagni's hernia, presenting with dyspepsia and chest pain, at the age 45 years. For many years the diagnosis remained a dilemma because patient's chest x-ray was not done and she was treated for 'ngina' and 'dyspepsia' Diagnosis was obvious once a chest x-ray was done, however, barium studies were performed for further confirmation. (author)

Associated morbidities to congenital diaphragmatic hernia and a relationship to human milk.

Science.gov (United States)

Froh, Elizabeth B; Spatz, Diane L

2012-08-01

The majority of what is known in the recent literature regarding human milk studies in the neonatal intensive care setting is specific to term and/or preterm infants (including very-low-birth-weight preterm infants). However, there is a lack of human milk and breastfeeding literature concerning infants with congenital anomalies, specifically infants diagnosed with congenital diaphragmatic hernia (CDH). By applying human milk research conducted among other populations of infants, this article highlights how human milk may have a significant impact on infants with CDH. Recent human milk studies are reviewed and then applied to the CDH population in regard to respiratory and gastrointestinal morbidities, as well as infection and length of stay. In addition, clinical implications of these relationships are discussed and suggestions for future research are presented.

Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

Energy Technology Data Exchange (ETDEWEB)

Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho [Armed Forces Capital Hospital, Seongnam (Korea, Republic of)

2007-01-15

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

International Nuclear Information System (INIS)

Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho

2007-01-01

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect

Laparoscopic repair of Morgagni hernia and cholecystectomy in a 40-year-old male with Down's sindrome. Report of a case.

Science.gov (United States)

De Paolis, P; Mazza, L; Maglione, V; Fronda, G R

2007-06-01

Morgagni-Larrey hernia (MH) is an unusual diaphragmatic hernia of the retrosternal region. Few cases of MH, treated laparoscopically, associated with Down's syndrome (DS) have been reported in literature. On October 2004, a DS 40-year-old male was admitted to our Department with mild abdominal pain and nausea. Hematochemical tests were within the normal range. Ultrasonography showed biliary sludge and multiple gallstones. Chest X-ray revealed a right-sided paracardiac mass that appeared as MH after a thoraco-abdominal computed tomography (CT). Four trocars were placed as a routinary cholecystectomy. Abdominal exploration confirmed the presence of a voluminous hernia through a wide diaphragmatic defect (12 cm) on the left side of the falciform ligament, containing the last 20 cm ileal loops and right colon with the third lateral of transverse. After retrograde cholecystectomy and reduction of the herniated ileo-colonic tract from multiple adherences, the defect was repaired with an interrupted 2/0 silk suture and then a running 2/0 polypropylene suture. Postoperative course was complicated by pulmonary edema but subsequently the patient was discharged without further complications and has no recurrence after 2 years. In conclusion, surgery is necessary for symptomatic MH and to prevent possible severe complications. We preferred laparoscopy for the reduced morbidity compared to laparotomy, even if in our case the postoperative course was not uneventful. There are still few comparative data about the modality of closure of the defect between primary repair with nonabsorbable suture material, in case of small defects, or continuous monofilament suture or prosthesis in case of large defects.

Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome.

Science.gov (United States)

Stępiński, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald

2016-06-01

A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome

OpenAIRE

St?pi?ski, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szyma?ska, Anna; Marczak, Jakub; Cicho?, Romuald

2016-01-01

A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

Toracoscopia nas hérnias diafragmáticas: estudo experimental em cães Thoracoscopic techniques in diaphragmatic hernias: experimental study in dogs

Directory of Open Access Journals (Sweden)

Carlos Afonso de Castro Beck

2004-12-01

Full Text Available Na classificação das hérnias diafragmáticas, a traumática é a forma mais prevalente em cães e gatos. A alteração, que se caracteriza por uma alteração anatômica, tem na correção cirúrgica, o tratamento recomendado. O presente estudo se propôs a avaliar a cirurgia videotoracoscópica no diagnóstico e tratamento de hérnias diafragmáticas em cães. Na primeira etapa do experimento, oito animais foram submetidos à produção de um modelo de hérnia diafragmática por meio do acesso laparoscópico. Após o período de uma semana, os cães foram submetidos à segunda etapa experimental através do acesso toracoscópico, tendo como finalidade o diagnóstico e a terapêutica cirúrgica. O acesso toracoscópico mostrou-se eficaz tanto no caráter diagnóstico das rupturas e dos deslocamentos, como na correção cirúrgica de reposição visceral e rafia diafragmática.The most common type of diaphragmatic hernia in dogs and cats is the traumatic one.As an anatomic alteration surgery is the elected treatment. The purpose of this study was to evaluate videothoracoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in eight dogs. In the first phase of the study diaphragmatic hernias were performed in the dogs through laparoscopic access. One week later the dogs were summited to a thoracoscopic surgery to make diagnostic and surgical correction. Thoracoscopic access showed to be efficient for identification of the defects and visceral displacements and for the surgical treatment.

Laparoscopia nas hérnias diafragmáticas: estudo experimental em cães Laparoscopic techniques in diaphragmatic hernias: experimental study in dogs

Directory of Open Access Journals (Sweden)

Carlos Afonso de Castro Beck

2004-12-01

Full Text Available A hérnia diafragmática traumática é a forma mais comum entre as hérnias diafragmáticas em cães e gatos e, por tratar-se de uma alteração anatômica, a terapêutica indicada é a sua correção cirúrgica. O presente estudo se propôs a avaliar a cirurgia videolaparoscópica no diagnóstico e tratamento dessa afecção em cães. Na primeira etapa do experimento, os animais foram submetidos à produção de um modelo de hérnia diafragmática. Após o período de uma semana, os cães foram submetidos à segunda etapa experimental por meio do acesso laparoscópico, tendo como finalidade o diagnóstico e a terapêutica cirúrgica. O acesso laparoscópico mostrou-se eficaz tanto na identificação das rupturas e dos deslocamentos como na correção cirúrgica de reposição visceral e rafia diafragmática nos oito cães do experimento.The most common type of diaphragmatic hernia in dogs and cats is the traumatic one. As an anatomic alteration, surgery is the elected treatment. The purpose of this study was to evaluate videolaparoscopic surgery in the diagnostic and treatment of diaphragmatic hernia in dogs. In the first phase of the study diaphragmatic hernias were performed in dogs. One week later the dogs were summited to a laparoscopic surgery to make diagnostic and surgical correction. Laparoscopic access showed to be efficient for identification of the defect and visceral displacement and for the surgical treatment.

Congenital diaphragmatic hernia: neonatal outcomes following referral to a paediatric surgical centre.

LENUS (Irish Health Repository)

Chukwu, J

2012-02-01

Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births. Estimates of postnatal survival range from 50 to 70% despite advances in neonatal care. Antenatal diagnosis is associated with termination of pregnancy in 25-50% pregnancy internationally which may not be reflective of the Irish population. We aimed to evaluate the mortality of infants with CDH who survived to admission in a tertiary referral paediatric hospital between 1996 and 2007. The Hospital In-Patient Enquiry system was used to determine the number of neonatal referrals for CDH to OLHSC between 1996 and 2007. Mortality, sex distribution, length of patient stay and the number of cases per year were examined. 141 neonates with CDH were over 12 years with approximately 12 referrals per annum of which 82 (58%) were male and 59 (42%) female. The average length of stay in the hospital was 33 (range 0-364) days. Overall 71% of the patients survived to discharge. In the first epoch (1996-2001) survival was 63% compared with 78% in the later epoch (2002-7). The overall survival for neonates with CDH presenting to OLCHC during the 12 year-period was 71% although this improved to 78% in recent epoch. Further study of associated congenital anomalies, number of terminations of pregnancy, complexity of the diaphragmatic defect and degree of pulmonary hypertension are required to compare this population with other international centres.

Traumatic lung hernia; Hernia pulmonar traumatica

Energy Technology Data Exchange (ETDEWEB)

Rabaza, M. J.; Alcazar, P. P.; Touma, C. [Hospital Universitario Virgen de las Nieves. Granada (Spain)

2001-07-01

Lung hernia is an uncommon entity that is defined as the protrusion of the lung parenchyma through a defect in the thoracic cavity. It is classified on the basis of its location (cervical, intercostal and diaphragmatic) and etiology (congenital and acquired). Acquired lung hernias can be further grouped as spontaneous, traumatic or pathological, depending on the responsible mechanism. Nearly half of them are secondary to chest trauma, whether penetrating or blunt. We present a case of lung hernia in a patient with penetrating chest trauma. The diagnosis was suspected from the radiographic images and was confirmed by computed tomography. We also review the literature concerning its classification and incidence, diagnostic methods used and treatment. (Author) 9 refs.

Re-evaluation of lung to thorax transverse area ratio immediately before birth in predicting postnatal short-term outcomes of fetuses with isolated left-sided congenital diaphragmatic hernia: A single center analysis.

Science.gov (United States)

Kido, Saki; Hidaka, Nobuhiro; Sato, Yuka; Fujita, Yasuyuki; Miyoshi, Kina; Nagata, Kouji; Taguchi, Tomoaki; Kato, Kiyoko

2018-05-01

We aimed to investigate whether the lung-to-thorax transverse area ratio (LTR) immediately before birth is of diagnostic value for the prediction of postnatal short-term outcomes in cases of isolated left-sided congenital diaphragmatic hernia (CDH). We retrospectively reviewed the cases of fetal isolated left-sided CDH managed at our institution between April 2008 and July 2016. We divided the patients into two groups based on LTR immediately before birth, using a cut-off value of 0.08. We compared the proportions of subjects within the two groups who survived until discharge using Fisher's exact test. Further, using Spearman's rank correlation, we assessed whether LTR was correlated with length of stay, duration of mechanical ventilation, and supplemental oxygen. Twenty-nine subjects were included (five with LTR < 0.08, and 24 with LTR ≥ 0.08). The proportion of subjects surviving until discharge was 40% (2/5) for patients with LTR < 0.08, as compared with 96% (23/24) for those with LTR ≥ 0.08. LTR measured immediately before birth was negatively correlated with the postnatal length of stay (Spearman's rank correlation coefficient, rs = -0.486), and the duration of supplemental oxygen (rs = -0.537). Further, the duration of mechanical ventilation was longer in patients with a lower LTR value. LTR immediately before birth is useful for the prediction of postnatal short-term outcomes in fetuses with isolated left-sided CDH. In particular, patients with prenatal LTR value less than 0.08 are at increased risk of postnatal death. © 2017 Japanese Teratology Society.

Congenital diaphragmatic hernia may be associated with 17q12 microdeletion syndrome.

Science.gov (United States)

Goumy, Carole; Laffargue, Fanny; Eymard-Pierre, Eléonore; Kemeny, Stéphen; Gay-Bellile, Mathilde; Gouas, Laetiti; Gallot, Denis; Francannet, Christine; Tchirkov, Andrei; Pebrel-Richard, Céline; Vago, Philippe

2015-01-01

Microdeletions of 17q12 encompassing TCF2 are associated with maturity-onset of diabetes of the young type 5, cystic renal disease, pancreatic atrophy, Mullerian aplasia in females and variable cognitive impairment. We report on a patient with a de novo 17q12 microdeletion, 1.8 Mb in size, associated with congenital diaphragmatic hernia (CDH). The 5-year-old male patient presented multicystic renal dysplasia kidneys, minor facial dysmorphic features and skeletal anomalies, but neither developmental delay nor behavioral abnormalities. CDH has been previously associated with the 17q12 microdeletion syndrome only in one prenatal case. The present study reinforces the hypothesis that CDH is part of the phenotype for 17q12 microdeletion and that 17q12 encompasses candidate(s) gene(s) involved in diaphragm development. We suggest that PIGW, a gene involved in an early step of GPI biosynthesis, could be a strong candidate gene for CDH. © 2014 Wiley Periodicals, Inc.

Piston-pump-type high frequency oscillatory ventilation for neonates with congenital diaphragmatic hernia: a new protocol.

Science.gov (United States)

Tamura, M; Tsuchida, Y; Kawano, T; Honna, T; Ishibashi, R; Iwanaka, T; Morita, Y; Hashimoto, H; Tada, H; Miyasaka, K

1988-05-01

High frequency ventilation and extracorporeal membrane oxygenation (ECMO) are devices that are expected to save the lives of newborn infants whose pulmonary conditions have deteriorated. A piston-pump-type high-frequency oscillator (HFO), developed by Bryan and Miyasaka called "Hummingbird," is considered to be superior to high frequency "jet" ventilators or those of the flow-interrupter type, and was used successfully in two neonates with congenital diaphragmatic hernia (CDH) in a high-risk group. The first baby was on a conventional ventilator with pharmacologic support for the first 54 hours and then operated on. Postoperative deterioration necessitated the use of HFO for the next eight days. The infant then recovered uneventfully. For the second baby, HFO was necessary both preoperatively and postoperatively. This baby had a major diaphragmatic defect and her case was complicated with pneumothorax. There was a long stormy course on HFO (total, 70 days), but the patient was successfully extubated on the 75th day postoperatively and is now doing well. We believe active long preoperative stabilization with pharmacologic support and preoperative and postoperative hyperventilation with a piston-pump-type HFO may be a new innovative strategy for the management of severe CDH patients.

Paper-thinned diaphragm: CT sign of diaphragmatic eventration

International Nuclear Information System (INIS)

Im, Jung Gi; Han, Man Chung; Kim, Chu Wan; Shim, Young Soo

1990-01-01

CT findings of total left hemidiaphragmatic eventration in two adult patients are described. Chest radiograph showed elevated left hemidiaphragm and left hilum. Paper-thinned muscular portion of the diseased diaphragm was clearly demonstrated with CT scan. With demonstration of paper-thinned diaphragm by CT scan, differentiation of the diaphragmatic eventration from recent onset phrenic nerve paralysis by tumor invasion or from post-traumatic diaphragmatic hernia can be made

Paper-thinned diaphragm: CT sign of diaphragmatic eventration

Energy Technology Data Exchange (ETDEWEB)

Im, Jung Gi; Han, Man Chung; Kim, Chu Wan; Shim, Young Soo [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

1990-10-15

CT findings of total left hemidiaphragmatic eventration in two adult patients are described. Chest radiograph showed elevated left hemidiaphragm and left hilum. Paper-thinned muscular portion of the diseased diaphragm was clearly demonstrated with CT scan. With demonstration of paper-thinned diaphragm by CT scan, differentiation of the diaphragmatic eventration from recent onset phrenic nerve paralysis by tumor invasion or from post-traumatic diaphragmatic hernia can be made.

Abnormal platelet-derived growth factor signaling accounting for lung hypoplasia in experimental congenital diaphragmatic hernia.

Science.gov (United States)

Dingemann, Jens; Doi, Takashi; Ruttenstock, Elke; Puri, Prem

2010-10-01

The pathogenesis of pulmonary hypoplasia in congenital diaphragmatic hernia (CDH) is not fully understood. Platelet-derived growth factor A (PDGFA) and platelet-derived growth factor receptor α (PDGFRα) play a crucial role in lung development. It has been reported that PDGF induces H(2)O(2)-production and that oxidative stress may be an important mechanism for the impaired lung development in the nitrofen rat model. We hypothesized that pulmonary expression of PDGFA and PDGFRα is altered in the nitrofen induced CDH model. Pregnant rats received 100 mg nitrofen or vehicle on gestational day 9 (D9) and were sacrificed on D15, D18 or D21. RNA was extracted from fetal left lungs and mRNA levels of PDGFA and PDGFRα were determined using real-time polymerase chain reaction. Immunohistochemistry for protein expression of PDGFA and PDGFRα was performed. Pulmonary H(2)O(2) was measured colorimetrically. mRNA levels of PDGFRα at D15 (4.50 ± 0.87) and PDGFA at D18 (2.90 ± 1.38) were increased in the nitrofen group (P stress during lung development. Copyright © 2010 Elsevier Inc. All rights reserved.

Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation.

Science.gov (United States)

Frisk, Virginia; Jakobson, Lorna S; Unger, Sharon; Trachsel, Daniel; O'Brien, Karel

2011-07-01

Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO). Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests. Non-ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics. Non-ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence. Copyright © 2011 Elsevier Inc. All rights reserved.

Left Sided Amyand's Hernia, A Rare Occurance: A Case Report.

Science.gov (United States)

Ravishankaran, Praveen; Mohan, G; Srinivasan, A; Ravindran, G; Ramalingam, A

2013-06-01

This is a case report about a 35 year old man admitted with complains of obstructed left sided inguinal hernia. On exploration of the left inguinal canal to our surprise a normal appendix was found in addition to a gangrenous omentum. Resection of the gangrenous omentum was done. Appendectomy was done. This case is reported for its rare occurance as only three such cases of left sided amyand's hernia has been reported so far in literature[4-6].

Traumatic diaphragmatic hernias: Retrospective analysis

Directory of Open Access Journals (Sweden)

J.P.A. Sousa

2006-05-01

Full Text Available Aims: This study classifies cases of traumatic diaphragmatic hernias (TDH in patients admitted to the Intensive Care Unit (ICU of the Coimbra University Hospitals (HUC from 1990 to 2004. Methods: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. Results: Twenty-eight male and six female patients with an average age of 40.5 years ± 20.5, average SAPS score 38.8. Average lenght of stay was 19.1 ± 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1% then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. Conclusions: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma. This diagnosis should always be considered a possibility in

Colon Perforations Causing Morgagni Hernia Case

Directory of Open Access Journals (Sweden)

Mustafa Ugur

2014-08-01

Full Text Available Herniation of the intraabdominal organs through a diaphragmatic defect that occurs due to the joining anomaly of the sternal and costal segments of diaphragm is known as Morgagni Hernia. Although most of the patients with Morgagni Hernia are asymptomatic, intestinal obstruction, incarceration and strangulation can rarely occur. An 83 years old female patient admitted with acute abdomen to our clinic. Morgagni hernia was detected with preoperative thoracic and abdominal computed tomography. We aimed to present our management in Morgagni Hernia in this study.

Blunt traumatic diaphragmatic rupture

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Antonio Carlos Nogueira

2011-09-01

Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging

International Nuclear Information System (INIS)

Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Herold, Christian; Prayer, Daniela; Brugger, Peter C.; Csapo, Bence

2010-01-01

To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome. Twenty-five fetuses (22-37 weeks' gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes. LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR. Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH. (orig.)

Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging

Energy Technology Data Exchange (ETDEWEB)

Balassy, Csilla; Kasprian, Gregor; Weber, Michael; Herold, Christian; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Centre of Anatomy and Cell Biology, Vienna (Austria); Csapo, Bence [Medical University of Vienna, Department of Obstetrics and Gyneocology, Vienna (Austria)

2010-04-15

To investigate developmental changes in the apparently unaffected contralateral lung by using signal intensity ratios (SIR) and lung volumes (LV), and to search for correlation with clinical outcome. Twenty-five fetuses (22-37 weeks' gestation) were examined. Lung/liver signal intensity ratios (LLSIR) were assessed on T1-weighted and T2-weighted sequences for both lungs, then together with LV compared with age-matched controls of 91 fetuses by using the U test. Differences in LLSIRs and lung volumes were correlated with neonatal outcomes. LLSIRs in fetuses with congenital diaphragmatic hernia (CDH) were significantly higher in both lungs on T1-weighted images and significantly lower on T2-weighted images, compared with normals (p < 0.05), increasing on T2-weighted imaging and decreasing on T1-weighted imaging during gestation. Total LV were significantly smaller in the CDH group than in controls (p < 0.05). No significant differences in LLSIR of the two lungs were found. Outcomes correlated significantly with total LV, but not with LLSIR. Changes in LLSIR seem to reflect developmental impairment in CDH; however, they provide no additional information in predicting outcome. LV remains the best indicator on fetal MR imaging of neonatal survival in isolated, left-sided CDH. (orig.)

ADULT ABDOMINAL WALL HERNIA IN IBADAN.

African Journals Online (AJOL)

... method for this surgical procedure.11,12 Laparoscopic mesh repair of ... surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with .... GROIN HERNIA (N=922). Side of hernia. Right. Left. Bilateral. Type of hernia. Direct.

Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Noemi Cantone

2016-01-01

Full Text Available Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.

Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature

Science.gov (United States)

Gulia, Caterina; Miele, Vittorio; Trinci, Margherita; Briganti, Vito

2016-01-01

Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia. PMID:27703832

Evaluation of Neonatal Lung Volume Growth by Pulmonary Magnetic Resonance Imaging in Patients with Congenital Diaphragmatic Hernia.

Science.gov (United States)

Schopper, Melissa A; Walkup, Laura L; Tkach, Jean A; Higano, Nara S; Lim, Foong Yen; Haberman, Beth; Woods, Jason C; Kingma, Paul S

2017-09-01

To evaluate postnatal lung volume in infants with congenital diaphragmatic hernia (CDH) and determine if a compensatory increase in lung volume occurs during the postnatal period. Using a novel pulmonary magnetic resonance imaging method for imaging neonatal lungs, the postnatal lung volumes in infants with CDH were determined and compared with prenatal lung volumes obtained via late gestation magnetic resonance imaging. Infants with left-sided CDH (2 mild, 9 moderate, and 1 severe) were evaluated. The total lung volume increased in all infants, with the contralateral lung increasing faster than the ipsilateral lung (mean ± SD: 4.9 ± 3.0 mL/week vs 3.4 ± 2.1 mL/week, P = .005). In contrast to prenatal studies, the volume of lungs of infants with more severe CDH grew faster than the lungs of infants with more mild CDH (Spearman's ρ=-0.086, P = .01). Although the contralateral lung volume grew faster in both mild and moderate groups, the majority of total lung volume growth in moderate CDH came from increased volume of the ipsilateral lung (42% of total lung volume increase in the moderate group vs 32% of total lung volume increase in the mild group, P = .09). Analysis of multiple clinical variables suggests that increased weight gain was associated with increased compensatory ipsilateral lung volume growth (ρ = 0.57, P = .05). These results suggest a potential for postnatal catch-up growth in infants with pulmonary hypoplasia and suggest that weight gain may increase the volume growth of the more severely affected lung. Copyright © 2017 Elsevier Inc. All rights reserved.

Congenital diaphragmatic hernia: a modern day approach.

Science.gov (United States)

Waag, Karl-Ludwig; Loff, Steffan; Zahn, Katrin; Ali, Mansour; Hien, Steffen; Kratz, Markus; Neff, Wolfgang; Schaffelder, Regine; Schaible, Thomas

2008-11-01

Centralization of all complicated congenital diaphragmatic hernias (CDH) was organized in Germany from 1998, collecting 325 consecutive patients with striking increasing survival rates. This series report 244 patients from 2002 to 2007. Today, large defects are detected early in pregnancy by ultrasound and magnetic resonance imaging (MRI). In extracorporeal membrane oxygenation (ECMO) patients, prenatal lung head ratio (LHR) was 1.2 (median) at the 34th week of gestation or less than 25 ml lung tissue in MRI. This means that all patients below LHR of 1.4 should be transferred prenatally in a tertiary center. High risk group for survival was defined as LHR below 0.9, ie, 10 ml in MRI planimetry. Inborn patients show better results than outborns. In algorithm therapy, gentle ventilation plays an important role in preventing damage to the lung tissue and avoiding long term ventilation. When PaCO(2) was more than 75 mmHg, ventilation was changed to high frequency oscillatory ventilation (HFOV). Indication for ECMO was seen in preductal PaO(2) less than 50 mmHg over 2-4 h or less than 40 mmHg over 2 h. ECMO related risks included intracerebral bleeding (9%), intrapulmonary bleeding (14%), and convulsions (16%). Surgically, a longitudinal midline incision for exposure of the defect, the duodenal kinking, and probably for abdominal patching was perfect. A cone formed goretex patch provided more abdominal space and reduced abundant intrathoracical cavity. No drain was used. Postoperative complications were described. Overall survival in 244 consecutive patients was 86.5% for all patients born alive. All those who needed ECMO survived in 71%, underlining ECMO as a treatment of last choice. Follow-up for quality of life after CDH is described.

Congenital retrosternal hernias of Morgagni: Manifestation and treatment in children

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Oleksii Slepov

2016-01-01

Full Text Available Background: Due to scarcity of congenital diaphragmatic hearnias of Morgagni (CDHM, non-specific clinical presentation in the pediatric age group, we aimed to investigate the incidence, clinical manifestations, anatomical characteristics, and develop diagnostic algorithm and treatment of CDHM in children. Materials and Methods: The patients′ records of children with CDHM treated in our hospital during past 20 years were retrospectively reviewed for the age at diagnosis, gender, clinical findings, anatomical features, operative details and outcome. Results: Since 1995 to 2014 we observed 6 (3 boys, 3 girls patients with CDHM, that comprise 3.2% of all congenital diaphragmatic hernia cases (n = 185. Age at diagnosis varied from 3 mo. to 10y.o. Failure to thrive was main symptom in 4 patients, followed by recurrent respiratory infections (n = 3, dyspnea (n = 3, and gastrointestinal manifestations: constipation (n = 2, abdominal pain (n = 1. Work-up consisted of plain X-ray for all (n = 6, upper GI (n = 3, barium enema (n = 2, sonography (n = 6 and CT (n = 2. Abdominal approach used in 5 patients, and thoracotomy in one. Herniated contents were: liver lobes (n = 4, transverse colon (n = 3 and greater omentum (n = 1. 5 had right-sided lesion, 1- left-sided. Defect repaired using local tissues. Post-operative course was uneventful; all patients appeared well during follow-up. Conclusion: CDHM is very uncommon anomaly, very occasionally diagnosed at the early age. Failure to thrive and recurrent respiratory infections are most frequent clinical manifestations. In suspected CDHM we advocate the following work-up: plain chest and abdominal X-ray, contrast study (upper GI series or barium enema, ultrasonographic screen and CT scan. Surgical repair via abdominal approach, using local tissues and hernia sac removal is preferred.

Correlation between US and MRI for prenatal lung volumetry in diaphragmatic hernia, and use of Doppler to identify the ipsilateral lung cap

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Castellote, Amparo; Mencho, Sandra; Cadavid, Lina; Piqueras, Joaquim; Enriquez, Goya [University Children' s Hospital Vall d' Hebron, Department of Pediatric Radiology, Barcelona (Spain); Carreras, Elena; Higueras, Teresa [University Hospital Vall d' Hebron, Department of Obstetrics and Gynecology, Barcelona (Spain)

2011-12-15

Pulmonary hypoplasia is a common cause of neonatal death. To describe the correlation between relative fetal lung volume (RFLV) and lung-to-head ratio (LHR) in fetuses with unilateral diaphragmatic hernia. Additionally, to describe identification of the ipsilateral lung cap by power Doppler. Single-institution study of consecutive fetuses with diaphragmatic hernia. LHR (by US) and RFLV (by MRI) were correlated in fetuses with and without an ipsilateral lung cap seen at MRI. In four, color/power Doppler was used to follow the pulmonary artery of the ipsilateral lung to identify the compressed cap. The study included 48 fetuses of 20-38 weeks' gestational age (mean, 26 weeks). Mean LHR was 1.52 (range, 0.6-3) in fetuses with a lung cap and 1.15 (range, 0.6-2.58) in fetuses without (P = 0.043). Mean RFLV was 47.4% (range, 18-80%) in fetuses with and 32.9% (range, 14-57%) in fetuses without a lung cap (P = 0.005). RFLV and LHR correlated (r = 0.41, P = 0.01 in those with a cap; r = 0.50, P = 0.05 in those without). Power Doppler identified the ipsilateral lung cap and pulsed Doppler confirmed pulmonary vascularization in four of four fetuses. LHR underestimates lung volume in fetuses with an ipsilateral lung cap. Power Doppler may be useful for identifying the cap. (orig.)

A rare case report of Morgagni Hernia with Organo-Axial Gastric Volvulus and concomitant Para-esophageal hernia, repaired laparoscopically in a Septuagenarian

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Amol Mittal

Full Text Available Introduction: Simultaneous occurrence of Morgagni and the Para-esophageal hernia is a rare clinical condition with eight case reports in the English-language literature and only four managed laparoscopically. We describe a case of a Septuagenarian patient with Morgagni and concomitant Para-esophageal hernia treated laparoscopically. Presentation of a case: A 71-year-old male patient, presented with a one-month history of regurgitation of acid, retrosternal burning and vomiting after eating. Computed tomography (CT imaging demonstrated a large anterior diaphragmatic hernia, with herniation of bowel loops and anterosuperior displacement of the gastric antrum along with a grade III Para-esophageal hernia. The patient underwent simultaneous laparoscopic repair of Morgagni and Para-esophageal hernia with mesh reinforcement with Nissen’s total anti-reflux fundoplication. The patient’s postoperative recovery was uneventful. Discussion: A Morgagni Hernia is a rare congenital condition consisting of a Subcosto-sternal defect in the diaphragm. A Para-esophageal hernia is a rare variant of a hiatus hernia. Morgagni and Para-esophageal hernia may present with gastric volvulus or incarceration, requiring emergency treatment. Minimally invasive surgery is the preferred treatment, particularly for elderly patients and patients with comorbidities. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. Conclusion: This case report highlights the co-existence of Morgagni and Para-esophageal hernias and validates the feasibility of laparoscopic repair of both hernias simultaneously. Keywords: Diaphragmatic hernia, Morgagni, Para-esophageal hernia, Minimally invasive surgery, Fundoplication, Case report

Congenital diaphramatic hernia

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Kline-Fath, Beth M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Fetal Care Center of Cincinnati, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States)

2012-01-15

Congenital diaphragmatic hernia, despite advances in therapy, remains a complex condition with significant morbidity and mortality. The etiology of the disorder is still incompletely understood, though the pulmonary hypoplasia and pulmonary hypertension that develop secondarily must be overcome to improve survival. Prenatal US and fetal MRI have helped in the development of a greater understanding of this disease. Also with these modalities, measurement techniques have been developed in an attempt to provide prognosticators for the development of pulmonary hypoplasia and pulmonary hypertension. There is a broad range of approaches for performing these measurements, and variability among imaging centers is noted. Despite inconsistent approaches, these techniques have become the foundation for counseling and prenatal and postnatal therapy. It is hoped that with further research with prenatal US and fetal MRI and the development of innovative medical and surgical therapies that the morbidity and mortality of children with congenital diaphragmatic hernias can be significantly reduced. (orig.)

Congenital diaphramatic hernia

International Nuclear Information System (INIS)

Kline-Fath, Beth M.

2012-01-01

Congenital diaphragmatic hernia, despite advances in therapy, remains a complex condition with significant morbidity and mortality. The etiology of the disorder is still incompletely understood, though the pulmonary hypoplasia and pulmonary hypertension that develop secondarily must be overcome to improve survival. Prenatal US and fetal MRI have helped in the development of a greater understanding of this disease. Also with these modalities, measurement techniques have been developed in an attempt to provide prognosticators for the development of pulmonary hypoplasia and pulmonary hypertension. There is a broad range of approaches for performing these measurements, and variability among imaging centers is noted. Despite inconsistent approaches, these techniques have become the foundation for counseling and prenatal and postnatal therapy. It is hoped that with further research with prenatal US and fetal MRI and the development of innovative medical and surgical therapies that the morbidity and mortality of children with congenital diaphragmatic hernias can be significantly reduced. (orig.)

Long-term nutritional morbidity for congenital diaphragmatic hernia survivors: Failure to thrive extends well into childhood and adolescence.

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Haliburton, Beth; Mouzaki, Marialena; Chiang, Monping; Scaini, Vikki; Marcon, Margaret; Moraes, Theo J; Chiu, Priscilla P

2015-05-01

Failure to thrive (FTT) is well documented among congenital diaphragmatic hernia (CDH) survivors ≤3years of age, but its etiology, severity, and persistence beyond this age require further elucidation. We conducted a single-center, retrospective study assessing anthropometrics, measured energy expenditure, and feeding tube (FT) use of 5-17 year olds in our multidisciplinary CDH clinic since January 2001. We stratified clinic visits based on age A: 5.0-6.9, B: 7.0-9.9, C: 10.0-14.9, and D: 15-17.9years. One hundred sixteen patients with 376 outpatient visits were reviewed. Anthropometric z-scores were below zero and did not vary across age cohorts. FTT and growth stunting each occurred in 14% of clinic visits. FTs inserted during infancy occurred in 25% of patients, and 60% remained by age 7years. In cohort A, those with FTs were lighter and shorter than those without (pFailure to thrive continues in long-term CDH survivors, FTs may not improve incidence of FTT. Increased energy expenditure may play a role. Copyright © 2015 Elsevier Inc. All rights reserved.

Traumatic lung hernia

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Rabaza, M. J.; Alcazar, P. P.; Touma, C.

2001-01-01

Lung hernia is an uncommon entity that is defined as the protrusion of the lung parenchyma through a defect in the thoracic cavity. It is classified on the basis of its location (cervical, intercostal and diaphragmatic) and etiology (congenital and acquired). Acquired lung hernias can be further grouped as spontaneous, traumatic or pathological, depending on the responsible mechanism. Nearly half of them are secondary to chest trauma, whether penetrating or blunt. We present a case of lung hernia in a patient with penetrating chest trauma. The diagnosis was suspected from the radiographic images and was confirmed by computed tomography. We also review the literature concerning its classification and incidence, diagnostic methods used and treatment. (Author) 9 refs

Laparoscopic repair of Morgagni diaphragmatic hernia in infants ...

African Journals Online (AJOL)

risk accruing from leaving the hernia sac intact. .... adenomatoid malformation of the lung, pneumohe- mothorax, anterior mediastinal mass, or lung abscess .... factor in the diagnosis, management and outcome in patients of Morgagni hernia.

Left-sided incarcerated Amyand’s hernia with cecum and terminal ileum: a case report

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Bekele K

2017-10-01

Full Text Available Kebebe Bekele,1 Desalegn Markos2 1Department of Surgery, School of Medicine, Madda Walabu University, Bale Robe, Ethiopia; 2Unit of Neonatology Nursing, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia Background: Amyand’s hernia, which is the presence of a normal or pathological appendix as a part of an inguinal hernia, is a rare clinical entity. We are reporting a very rare case of left-sided incarcerated Amyand’s hernia with cecum and terminal ileum involvement. Case presentation: A 4-year-old male child with left inguinal swelling of 2-year duration presented to Goba Referral Hospital. Two days before the patient visited our hospital, the swelling had become irreducible and caused severe groin pain. He had abdominal cramps, bilious vomiting, and mild abdominal distention, but passed feces. With the diagnosis of left-sided incarcerated inguinal hernia, the patient was investigated and prepared for surgical management. During the operative procedure, we identified the presence of appendix, cecum, and terminal ileum in the scrotum as the herniated component. After the sack was dissected, since there was also appendicitis, an appendectomy was performed. Then, high ligation of sack was done after cecum and ileum were reduced. After 3 uneventful postoperative days in the hospital, the patient was discharged. The patient was followed-up for 6 months, and he did not develop any complications. Conclusion: Left-sided incarcerated Amyand’s hernia with cecum and terminal ileum involvement is a rare clinical entity. Even though it is not common, appendicitis is one of the comorbidities that can be seen in patients with left-sided incarcerated Amyand’s hernia with cecum and terminal ileum. Surgeons should have a high index of clinical suspicion and be aware of the potential involvement of appendix, cecum, and ileum as part of an incarcerated hernia during surgery, even in the left inguinal region. In this case, left-sided

[Type IV paraesophageal hernia with 60% of gastric necrosis. Case report].

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Navarro-Tovar, Fernando; Juárez-de La Torre, Juan Carlos; Pérez-Ayala, Luis Carlos; Quintero-Cabrera, Eduardo

2014-01-01

Paraesophageal hernias are rare and, when associated with symptoms, the risk of complications increases, becoming a surgical emergency. We report a case of a 53 year-old female with 3 weeks of clinical evolution including abdominal pain, nausea and occasional vomiting; 24 h prior to admission she presented intestinal occlusion. Radiographic and tomographic findings showed a paraesophageal hernia, requiring exploratory laparotomy, which demonstrated a 9 cm paraesophageal diaphragmatic defect with a hernia sac containing transverse colon, omentum, fundus and body of the stomach (this last one presented ~60% of necrosis), performing nonanatomic gastrectomy and simple diaphragmatic reconstruction. The patient had a complicated postoperative period requiring two additional surgeries attempting to correct gastrectomy dehiscence and ending with a third procedure for cervical esophagostomy and Witzel jejunostomy. Elective repair is recommended in all patients with asymptomatic paraesophageal hernia in order to avoid possible complications. The approach method is dependent on the surgeon's experience and the conditions of the hernia and involved structures at the time of diagnosis.

Making meaning of pumping for mothers of infants with congenital diaphragmatic hernia.

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Froh, Elizabeth B; Deatrick, Janet A; Curley, Martha A Q; Spatz, Diane L

2015-01-01

To describe the process of initiation and maintenance of milk supply and potential transition to direct breastfeeding among mother/infant dyads with infants with congenital diaphragmatic hernia (CDH). A Level-III neonatal intensive care unit. Eleven mother/infant dyads with infants with CDH. Prospective, longitudinal qualitative descriptive design. Semistructured interviews were conducted over the course of the NICU stay. Conventional content analysis was used. Human milk oral care emerged from the interview data as a strong facilitating factor to encouraging mothers to continue pumping during hospitalization. Four main themes emerged regarding the importance and value of human milk oral care for the mothers in relation to pumping and maintenance of milk supply: (a) It motivates me; (b) I'm a part of my baby getting better; (c) We do it together, and (d) We're getting somewhere. The findings of this study reflect the importance and value of human milk oral care as a driving factor to motivate mothers to maintain milk supply during the critical time when the infant with CDH is not able to take in enteral nutrition and throughout the hospital stay. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia.

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Stege, Gerben; Fenton, Alan; Jaffray, Bruce

2003-09-01

Reported survival in congenital diaphragmatic hernia (CDH) fails to allow for case selection bias. This study reports the incidence of CDH in a geographically defined population over 11 years and assesses the effect of new therapies (high-frequency oscillatory ventilation, extracorporeal membrane oxygenation, inhaled nitric oxide, and delayed surgery) on survival when case selection is avoided. A retrospective review of cases from a regional case registry, the Northern Region Congenital Anomaly Survey, was conducted. A total of 185 cases were identified. Mortality was 62% and did not vary significantly during the study period. Mortality was unaffected by the introduction of new therapies. There was a significant inverse correlation between the rate of elective termination and survival of live borns. The presence of an additional anomaly increased mortality to 79%. The mortality of CDH when complete case ascertainment is achieved is unaffected by new therapies. The survival rate is principally determined by the rate of antenatal termination and the incidence of associated anomalies. Reports of improved survival of CDH should be interpreted with caution, as variations in outcome are more likely to be explained by case selection artifact.

Distal 4p microdeletion in a case of Wolf-Hirschhorn syndrome with congenital diaphragmatic hernia.

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Casaccia, Germana; Mobili, Luisa; Braguglia, Annabella; Santoro, Francesco; Bagolan, Pietro

2006-03-01

Wolf-Hirschhorn syndrome (WHS) is a well-known genetic condition characterized by typical facial anomalies, midline defects, skeletal anomalies, prenatal and postnatal growth retardation, hypotonia, mental retardation, and seizures. Affected patients with a microdeletion on distal 4p present a milder phenotype that lacks congenital malformations. WHS is rarely associated with congenital diaphragmatic hernia (CDH), and only 8 cases are reported in the literature. In almost all cases of CDH and WHS a large deletion of the short arm of chromosome 4 is present. A microdeletion of 2.6 Mb on distal 4p associated with CDH and multiple congenital malformations (i.e., cleft palate) is reported for the first time. Such a microdeletion should prompt a molecular study for WHS when in a fetus/newborn with CDH the association with cleft lip/palate and typical facial appearance (flat facial profile, hypertelorism) is found. Copyright 2006 Wiley-Liss, Inc.

MR diagnosis of diaphragmatic endometriosis

International Nuclear Information System (INIS)

Rousset, Pascal; Gregory, Jules; Coste, Joel; Rousset-Jablonski, Christine; Hugon-Rodin, Justine; Regnard, Jean-Francois; Chapron, Charles; Golfier, Francois; Revel, Marie-Pierre

2016-01-01

To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

MR diagnosis of diaphragmatic endometriosis

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Rousset, Pascal [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Radiology Department, Pierre Benite (France); Gregory, Jules; Coste, Joel [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Biostatistics and Epidemiology department, Paris (France); Rousset-Jablonski, Christine [Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Hugon-Rodin, Justine [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Gynecology Endocrinology Department, Paris (France); Regnard, Jean-Francois [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Thoracic Surgery Department, Paris (France); Chapron, Charles [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Obstetric and Gynecologic Department, Paris (France); Golfier, Francois [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Revel, Marie-Pierre [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Radiology Department, Paris (France)

2016-11-15

To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

Surgical and nonsurgical treatment of peritoneopericardial diaphragmatic hernia in dogs and cats: 58 cases (1999-2008).

Science.gov (United States)

Burns, Colby G; Bergh, Mary Sarah; McLoughlin, Mary A

2013-03-01

To determine clinical findings and outcomes for cats and dogs with peritoneopericardial diaphragmatic hernia (PPDH) treated surgically or nonsurgically. Retrospective case series. 28 dogs and 30 cats. Medical records for cats and dogs evaluated at 1 of 2 veterinary teaching hospitals were reviewed, and data regarding clinical signs, diagnostic and surgical findings, and outcome were evaluated. Prevalence of PPDH in the 2 hospitals during the study period was 0.025% (0.062% and 0.015% for cats and dogs, respectively); PPDH was an incidental finding for 13 (46.4%) dogs and 15 (50.0%) cats. Other congenital abnormalities were identified in 16 (571%) dogs and 7 (23.3%) cats (most commonly umbilical hernias, abdominal wall hernias cranial to the umbilicus, or sternal anomalies). Thirty-four (58.6%) animals underwent surgical repair of PPDH; 27 (79.4%) of these animals had a primary diagnosis of PPDH. Detection of clinical signs of PPDH (primary diagnosis) and intestines in the pericardial sac were significantly associated with surgical treatment. Short-term mortality rate for surgically treated animals was 8.8% (3/34). Clinical signs associated with PPDH resolved in 29 (85.3%) of surgically treated animals. No significant differences were detected between dogs and cats or between surgically and nonsurgically treated animals regarding long-term survival rate. Results of this study indicated animals with clinical signs of PPDH were more likely to undergo surgery than were animals without such signs. Herniorrhaphy was typically effective for resolution of clinical signs. Long-term survival rates were similar regardless of treatment method. Surgical or nonsurgical treatment of PPDH may be appropriate for animals with or without clinical signs, respectively.

Sepsis risk factors in infants with congenital diaphragmatic hernia.

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Levy, Michaël; Le Sache, Nolwenn; Mokhtari, Mostafa; Fagherazzi, Guy; Cuzon, Gaelle; Bueno, Benjamin; Fouquet, Virginie; Benachi, Alexandra; Eleni Dit Trolli, Sergio; Tissieres, Pierre

2017-12-01

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown. This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH. During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thoracic position of liver were significantly associated with the occurrence of sepsis. Infected patients had longer duration of mechanical and noninvasive ventilation (16.2 and 5.8 days, respectively), longer delay to first feeding (1.2 days) and a longer length of stay in ICU (23 days), but there was no difference in mortality. Healthcare-associated infections, and more specifically VAP, are the main infective threat in children with CDH. Sepsis has a significant impact on the duration of ventilator support and ICU length of stay but does not impact mortality. Low gestational age and intra-thoracic localization of the liver are two independent risk factors associated with sepsis.

Right sided traumatic diaphragmatic hernia repair with intrathoracic herniation of liver, stomach and transverse colon

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Surendra Patel

2015-07-01

Full Text Available Traumatic rupture of the right dome of the diaphragm is an uncommon clinical entity. The diagnosis is difficult due to lack of specificity in clinical signs and chest film findings. Clinical incidence of rupture of the right dome of the diaphragm due to blunt trauma is much less common (10% compared to the left (90% and usually associated with more grievous injuries with very high pre hospital mortality thus accounting for rare clinical diagnosis. We report a case of 26 year old male who had the blunt trauma chest referred to us after 7 days of injury with complaints of shortness of breath and vomiting. On investigations the patient was diagnosed as a case of the ruptured right dome of the diaphragm with intrathoracic herniation of the stomach. The patient also had fracture pelvis. Surgical exploration was done through right 6th intercostal space which revealed intrathoracic herniation of the stomach, liver and transverse colon, which were healthy. Contents reduced into the abdomen and diaphragm was repaired. Post operative chest X-ray suggested complete expansion of the right lung with no residual herniation of abdominal contents. Post operative recovery was uneventful with the patient discharged on 14th post operative day.

Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair

International Nuclear Information System (INIS)

Weis, M.; Sommer, V.; Hagelstein, C.; Schoenberg, S.O.; Neff, K.W.; Zoellner, F.G.; Zahn, K.; Schaible, T.

2016-01-01

With a region of interest (ROI)-based approach 2-year-old children after congenital diaphragmatic hernia (CDH) show reduced MR lung perfusion values on the ipsilateral side compared to the contralateral. This study evaluates whether results can be reproduced by segmentation of whole-lung and whether there are differences between the ROI-based and whole-lung measurements. Using dynamic contrast-enhanced (DCE) MRI, pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) were quantified in 30 children after CDH repair. Quantification results of an ROI-based (six cylindrical ROIs generated of five adjacent slices per lung-side) and a whole-lung segmentation approach were compared. In both approaches PBF and PBV were significantly reduced on the ipsilateral side (p always <0.0001). In ipsilateral lungs, PBF of the ROI-based and the whole-lung segmentation-based approach was equal (p=0.50). In contralateral lungs, the ROI-based approach significantly overestimated PBF in comparison to the whole-lung segmentation approach by approximately 9.5 % (p=0.0013). MR lung perfusion in 2-year-old children after CDH is significantly reduced ipsilaterally. In the contralateral lung, the ROI-based approach significantly overestimates perfusion, which can be explained by exclusion of the most ventral parts of the lung. Therefore whole-lung segmentation should be preferred. (orig.)

Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair

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Weis, M.; Sommer, V.; Hagelstein, C.; Schoenberg, S.O.; Neff, K.W. [Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Zoellner, F.G. [Heidelberg University, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim (Germany); Zahn, K. [University of Heidelberg, Department of Paediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Schaible, T. [Heidelberg University, Department of Paediatrics, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany)

2016-12-15

With a region of interest (ROI)-based approach 2-year-old children after congenital diaphragmatic hernia (CDH) show reduced MR lung perfusion values on the ipsilateral side compared to the contralateral. This study evaluates whether results can be reproduced by segmentation of whole-lung and whether there are differences between the ROI-based and whole-lung measurements. Using dynamic contrast-enhanced (DCE) MRI, pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) were quantified in 30 children after CDH repair. Quantification results of an ROI-based (six cylindrical ROIs generated of five adjacent slices per lung-side) and a whole-lung segmentation approach were compared. In both approaches PBF and PBV were significantly reduced on the ipsilateral side (p always <0.0001). In ipsilateral lungs, PBF of the ROI-based and the whole-lung segmentation-based approach was equal (p=0.50). In contralateral lungs, the ROI-based approach significantly overestimated PBF in comparison to the whole-lung segmentation approach by approximately 9.5 % (p=0.0013). MR lung perfusion in 2-year-old children after CDH is significantly reduced ipsilaterally. In the contralateral lung, the ROI-based approach significantly overestimates perfusion, which can be explained by exclusion of the most ventral parts of the lung. Therefore whole-lung segmentation should be preferred. (orig.)

Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog

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H.F. Hartmann

2015-12-01

Full Text Available ABSTRACT Pleuroperitoneal hernias are the most uncommon type of diaphragmatic hernias in dogs and cats. The treatment of choice is surgery and may involve the use of prosthetic implant through celiotomy. In the current report, laparoscopic repair of a congenital pleuroperitoneal hernia using polypropylene mesh in a dog is described. The surgery was feasible. Appropriate reduction of the hernia was carried out and no complications were noted.

Imaging findings in fetal diaphragmatic abnormalities

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Alamo, Leonor; Gudinchet, Francois [University Hospital Center of Lausanne, Unit of Radiopediatrics, Department of Radiology, Lausanne (Switzerland); Meuli, Reto [University Hospital Center of Lausanne, Department of Radiology, Lausanne (Switzerland)

2015-12-15

Imaging plays a key role in the detection of a diaphragmatic pathology in utero. US is the screening method, but MRI is increasingly performed. Congenital diaphragmatic hernia is by far the most often diagnosed diaphragmatic pathology, but unilateral or bilateral eventration or paralysis can also be identified. Extralobar pulmonary sequestration can be located in the diaphragm and, exceptionally, diaphragmatic tumors or secondary infiltration of the diaphragm from tumors originating from an adjacent organ have been observed in utero. Congenital abnormalities of the diaphragm impair normal lung development. Prenatal imaging provides a detailed anatomical evaluation of the fetus and allows volumetric lung measurements. The comparison of these data with those from normal fetuses at the same gestational age provides information about the severity of pulmonary hypoplasia and improves predictions about the fetus's outcome. This information can help doctors and families to make decisions about management during pregnancy and after birth. We describe a wide spectrum of congenital pathologies of the diaphragm and analyze their embryological basis. Moreover, we describe their prenatal imaging findings with emphasis on MR studies, discuss their differential diagnosis and evaluate the limits of imaging methods in predicting postnatal outcome. (orig.)

Traumatic diaphragmatic ruptures: clinical presentation, diagnosis and surgical approach in adults

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Hofmann, Sabine

2012-01-01

Full Text Available Objective: Traumatic diaphragmatic injuries are rare, but potentially life-threatening due to herniation of abdominal organs into the pleural cavities. They can be easily overlooked on initial diagnostics and a high index of suspicion is required. The aim of this retrospective study was to analyze the clinical presentation, diagnostic methods and surgical management of patients with diaphragmatic rupture at our institution. Methods: A retrospective study was performed to analyze our experience with patients suffering from traumatic diaphragmatic rupture. Charts were reviewed for sex, age, side-location, concomitant injuries, time-to-diagnosis, diagnostic methods, surgical approach and outcome. Results: Fourteen patients (median age: 46 yrs, range 18–71, 9 male, 5 female with diaphragmatic injuries (left side: 10, right side: 4 were treated between July 2003 and September 2011. Mechanism of injury was a penetrating trauma (14%, blunt trauma (50% and others (36%. Associated abdominal injuries included spleen rupture (n=3, liver laceration (n=2, abdominal wall laceration (n=2 and gastric perforation (n=1. Computed tomography was the most sensitive diagnostic method. All patients underwent trans-abdominal repair of the diaphragmatic defect (direct suture: 10, prosthetic mesh insertion: 4. Associated abdominal procedures included splenectomy (n=3, liver packing (n=2, abdominal wall reconstruction (n=2 and partial gastric resection (n=1. Morbidity and hospital mortality rate were 36% and 0%, respectively. Median postoperative hospital stay was 17 days (range: 7–40 days. Conclusion: Morbidity and mortality of diaphragmatic ruptures are mainly determined by associated injuries or complications of diaphragmatic herniation like incarceration of viscera or lung failure. Early diagnosis helps to prevent severe complications. Spiral CT-scan is the most reliable tool for acute diagnosis of diaphragmatic rupture and associated visceral lacerations

The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus.

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Esen, K; Tok, S; Balci, Yuksel; Apaydin, F D; Kara, E; Uzmansel, D

2018-01-01

The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p renal artery origin and renal artery- -diaphragmatic crus contact at the left (p renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

Decreased Rac1 Cardiac Expression in Nitrofen-Induced Diaphragmatic Hernia.

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Nakamura, Hiroki; Zimmer, Julia; Puri, Prem

2018-02-01

 The high incidence of cardiac malformations in humans and animal models with congenital diaphragmatic hernia (CDH) is well known. The hypoplasia of left heart is common among fetuses with CDH and has been identified as a poor prognostic factor. However, the precise mechanisms underlying cardiac maldevelopment in CDH are not fully understood. Ras-related C3 botulinum toxin substrate 1 (Rac1) plays a key role in cardiomyocyte polarity and embryonic heart development. Deficiency of Rac1 is reported to impair elongation and cytoskeletal organization of cardiomyocytes, resulting in congenital cardiac defects. We designed this study to test the hypothesis that Rac1 expression is downregulated in the developing hearts of rats with nitrofen-induced CDH.  Following ethical approval (REC1103), time-pregnant Sprague Dawley rats received nitrofen or vehicle on gestational day 9 (D9). Fetuses were sacrificed on D18 and D21 and divided into CDH and control (CTRL) ( n  = 6 for each group and time point). Quantitative real-time polymerase chain reaction (qRT-PCR), Western blotting, and confocal-immunofluorescence microscopy were performed to detect cardiac gene and protein expression of Rac1.  qRT-PCR and Western blot analysis revealed that Rac1 expression was significantly decreased in the CDH group compared with controls ( p  Rac1 cardiac expression was markedly decreased in the CDH group compared with controls.  Decreased cardiac Rac1 expression in the nitrofen-induced CDH suggests that Rac1 deficiency during morphogenesis may impair structural cardiac remodeling, resulting in congenital cardiac defects. Georg Thieme Verlag KG Stuttgart · New York.

Incidence and factors associated with sensorineural and conductive hearing loss among survivors of congenital diaphragmatic hernia.

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Partridge, Emily A; Bridge, Christina; Donaher, Joseph G; Herkert, Lisa M; Grill, Elena; Danzer, Enrico; Gerdes, Marsha; Hoffman, Casey H; D'Agostino, Jo Ann; Bernbaum, Judy C; Rintoul, Natalie E; Peranteau, William H; Flake, Alan W; Adzick, N Scott; Hedrick, Holly L

2014-06-01

The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution. We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann-Whitney t-test (p≤0.05). A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p=0.0130), prolonged course of hospitalization (p=0.0011), duration of mechanical ventilation (p=0.0046), requirement for tracheostomy (p=0.0013), and duration of loop diuretic (p=0.0005) and aminoglycoside therapy (p=0.0003). We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language. Copyright © 2014 Elsevier Inc. All rights reserved.

Two Ports Laparoscopic Inguinal Hernia Repair in Children

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Medhat M. Ibrahim

2015-01-01

Full Text Available Introduction. Several laparoscopic treatment techniques were designed for improving the outcome over the last decade. The various techniques differ in their approach to the inguinal internal ring, suturing and knotting techniques, number of ports used in the procedures, and mode of dissection of the hernia sac. Patients and Surgical Technique. 90 children were subjected to surgery and they undergone two-port laparoscopic repair of inguinal hernia in children. Technique feasibility in relation to other modalities of repair was the aim of this work. 90 children including 75 males and 15 females underwent surgery. Hernia in 55 cases was right-sided and in 15 left-sided. Two patients had recurrent hernia following open hernia repair. 70 (77.7% cases were suffering unilateral hernia and 20 (22.2% patients had bilateral hernia. Out of the 20 cases 5 cases were diagnosed by laparoscope (25%. The patients’ median age was 18 months. The mean operative time for unilateral repairs was 15 to 20 minutes and bilateral was 21 to 30 minutes. There was no conversion. The complications were as follows: one case was recurrent right inguinal hernia and the second was stitch sinus. Discussion. The results confirm the safety and efficacy of two ports laparoscopic hernia repair in congenital inguinal hernia in relation to other modalities of treatment.

[Results of the treatment of congenital diaphagmatic hernia with conventional terapeutics modalities].

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Luis, A L; Avila, L F; Encinas, J L; Andrés, A M; Suárez, O; Elorza, D; Rodríguez, I; Martínez, L; Murcia, J; Lassaletta, L; Tovar, J A

2006-07-01

In this study, we analyze our results in the treatment of congenital diaphragmatic hernia (CDH) using conventional ventilatory therapy without ECMO. fifty one CDH patients (27 males and 24 females) treated at our institution between 1997 and 2004 were reviewed. Data referred to obstetrics, prenatal diagnosis, newborn care, type of hernia and surgical treatment were analyzed. We recorded ventilatory treatment modalities and the outcome of the patients. We also compared the survival of our series with those expected using the formula proposed by the CDH study group in 2001. We finally analized separately those patients with early clinical presentation and who fulfilled ECMO criteria. Data from necropsies were also recovered when available. Prenatal diagnosis was made in 58% of the patients. Fifty nine percent were born by c-section. The diaphragmatic defect was left-sided in 42 patients, right in 8 and bilateral in 1. Ten patients needed a prosthetic patch to close the defect. Eighteen out of the 51 patients (35%) died, 11 of them without surgical treatment. Early presentation of clinical picture was evident in 44 patients; among them 46% required high frequency ventilation and 53% nitric oxide therapy. Medium age at operation was 56+/-49 hours. The 7 children with late clinical presentation are alive. Among the 44 remaining patients, 26 are also alive (59,09%), data similar to those expected by the formula (62.39%, p>0.05). Fifteen patients had oxigenation index (IO) over 40, with a stimated survival rate of 48%, a statistically significant lower rate when compared to patients with IO40 survived; in 4 out of the 7 available necropsy studies, a severe lung hypoplasia was found (index lung weight/body weight ventilatory measures in patients with IO40 are rarely candidates to ECMO therapy because of the associated severe lung hypoplasia confirmed by necropsy studies.

Comparison between late-presenting and isolated neonatal congenital diaphragmatic hernias

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Christos Plataras

2011-01-01

Full Text Available Purpose: Late-presenting posterolateral congenital diaphragmatic hernias (CDH are anatomically similar to isolated neonatal CDH but are diagnosed and treated after the first month of life. We aim to characterise the clinical manifestations and short-term postoperative course of this entity and compare it with isolated CDH of the neonatal period. Materials and Methods: In the 30-year period from 1980 to 2010, 116 children with CDH were treated at the Aghia Sophia Children′s Hospital, Athens, Greece. Twenty-three (19% of these children were late-presenting cases, being diagnosed between the ages of 1 month and 4 years. Ninety-three were neonatal cases, of whom 22 (24% were excluded due to severe associated anomalies, leaving 71 cases of isolated neonatal CDH. We compared these two groups of patients with regard to preoperative symptoms, postoperative hospital stay, time to complete feeding, overall complication rate, and reoperation rate. Results: Isolated neonatal cases presented more often with acute respiratory symptoms (n=25; P= 0.016 and failure to thrive (n= 38; P= 0.03. Late-presenting cases presented more often with chronic respiratory symptoms (n=14;P= 0.0044 or gastrointestinal symptoms (n=12; P= 0.006. Thirty-five cases with minor or serious complications were reported in the neonatal group, whereas only five complications were observed in the late-presenting group (P= 0.028. We did not record any recurrences or reoperations in the late-presenting group, but we had two recurrences and three reoperations in the neonatal group. Time to full feeds and postoperative hospital stay was shorter in the late-presenting group. Conclusions: Our data demonstrate differences between the two groups in preoperative symptoms and short-term postoperative complications and short-term outcome. Late-presenting cases of CDH had a greater number of chronic symptoms preoperatively, more favorable postoperative outcomes, and less recurrences and reoperations.

A Case of Fatal Pulmonary Hypoplasia with Congenital Diaphragmatic Hernia, Thoracic Myelomeningocele, and Thoracic Dysplasia.

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Ito, Ai; Fujinaga, Hideshi; Matsui, Sachiko; Tago, Kumiko; Iwasaki, Yuka; Fujino, Shuhei; Nagasawa, Junko; Amari, Shoichiro; Kaneshige, Masao; Wada, Yuka; Takahashi, Shigehiro; Tsukamoto, Keiko; Miyazaki, Osamu; Yoshioka, Takako; Ishiguro, Akira; Ito, Yushi

2017-10-01

Background  Congenital diaphragmatic hernia (CDH) is fatal in severe cases of pulmonary hypoplasia. We experienced a fatal case of pulmonary hypoplasia due to CDH, thoracic myelomeningocele (MMC), and thoracic dysplasia. This constellation of anomalies has not been previously reported. Case Report  A male infant with a prenatal diagnosis of thoracic MMC with severe hydrocephalus and scoliosis was born at 36 weeks of gestation. CDH was found after birth and the patient died of respiratory failure due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn at 30 hours of age despite neonatal intensive care. An autopsy revealed a left CDH without herniation of the liver or stomach into the thoracic cavity, severe hydrocephalus, Chiari malformation type II, MMC with spina bifida from Th4 to Th12, hemivertebrae, fused ribs, deformities of the thoracic cage and legs, short trunk, and agenesis of the left kidney. Conclusion  We speculate that two factors may be associated with the severe pulmonary hypoplasia: decreased thoracic space due to the herniation of visceral organs caused by CDH and thoracic dysplasia due to skeletal deformity and severe scoliosis.

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

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McHugh, Kieran; Afaq, Asim; Roebuck, Derek J. [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom); Broderick, Nigel [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Gabra, Hany O.; Elliott, Martin J. [Great Ormond Street Hospital for Children, Department of Cardiothoracic Surgery, London (United Kingdom)

2010-05-15

Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition. (orig.)

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

International Nuclear Information System (INIS)

McHugh, Kieran; Afaq, Asim; Roebuck, Derek J.; Broderick, Nigel; Gabra, Hany O.; Elliott, Martin J.

2010-01-01

Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition. (orig.)

Tracheomegaly: a complication of fetal endoscopic tracheal occlusion in the treatment of congenital diaphragmatic hernia

Energy Technology Data Exchange (ETDEWEB)

McHugh, Kieran; Afaq, Asim; Roebuck, Derek J [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom); Broderick, Nigel [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Gabra, Hany O; Elliott, Martin J [Great Ormond Street Hospital for Children, Department of Cardiothoracic Surgery, London (United Kingdom)

2010-05-15

Fetal endoscopic tracheal occlusion (FETO) is a promising treatment for severe congenital diaphragmatic hernia, a condition that carries significant morbidity and mortality. It is hypothesised that balloon occlusion of the fetal trachea leads to an improvement in lung growth and development. The major documented complications of FETO to date are related to preterm delivery. To report a series of five infants who developed tracheomegaly following FETO. Review of all children referred with tracheomegaly to the paediatric intensive care and tracheal service at two referral centres. Five neonates presented with features of respiratory distress shortly after birth and were subsequently found to have marked tracheomegaly. Two neonates had tracheomalacia in addition. There are no previous reports in the literature describing tracheomalacia, or more specifically, tracheomegaly, as a consequence of FETO. We propose that the particularly compliant fetal airway is at risk of mechanical damage from in utero balloon occlusion. This observation of a new problem in this cohort suggests a thorough evaluation of the trachea should be performed in children who have had FETO in utero. It may be that balloon occlusion of the trachea earlier in utero (before 26 weeks' gestation) predisposes to this condition. (orig.)

The Canadian Pediatric Surgery Network (CAPSNet): Lessons Learned from a National Registry Devoted to the Study of Congenital Diaphragmatic Hernia and Gastroschisis.

Science.gov (United States)

Butler, Alison E; Puligandla, Pramod S; Skarsgard, Erik D

2015-12-01

The Canadian Pediatric Surgery Network (CAPSNet) was created in 2005 by a geographically representative, multidisciplinary group of clinicians and researchers with the intent of establishing a national research registry for gastroschisis (GS) and congenital diaphragmatic hernia (CDH). Since then, CAPSNet has used this registry and its 16-center network to make contributions to the knowledge base informing best practices for GS and CDH care. More recently, CAPSNet has expanded its focus to include quality assurance and improvement at each of its sites, by issuing a benchmarked outcomes "report card" with its annual report. Finally, a major objective of CAPSNet has been to establish and adopt standardized, evidence-based practice guidelines for GS and CDH across all Canadian perinatal centers. Georg Thieme Verlag KG Stuttgart · New York.

Management of diaphragmatic rupture from blunt trauma.

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Tan, K K; Yan, Z Y; Vijayan, A; Chiu, M T

2009-12-01

Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the

Hernia diafragmática traumática multivisceral: A propósito de 1 caso

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Armando Leal Mursulí

1999-08-01

Full Text Available La hernia diafragmática constituye un problema infrecuente para el cirujano de trauma, y se necesita un alto índice de sospecha para su diagnóstico, especialmente en los casos de trauma cerrado. Se presenta un paciente operado por esta afección, luego de sufrir trauma cerrado torácico izquierdo, al que se le halla hernia diafragmática multivisceral, formada por colon transverso, bazo y epiplón mayor. Se hace referencia a los principales medios para llegar al diagnóstico, así como a los principios fundamentales para la reparación de estas lesionesDiaphragmatic hernia is an uncommon problem for the trauma surgeon and it is necessary a high index of suspicion for its diagnosis, specially in those cases of closed trauma. A patient operated on of multivisceral diaphragmatic hernia composed of transverse colon, spleen and greater omentum, after suffering from closed left thoracic trauma is presented. Reference is made to the main aids used to determine the diagnosis and to the fundamental principles considered to repair these lesions

Gastric volvulus through morgagni hernia: an easily overlooked emergency.

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Sonthalia, Nikhil; Ray, Sayantan; Khanra, Dibbendhu; Saha, Avishek; Maitra, Subhasis; Saha, Manjari; Talukdar, Arunansu

2013-06-01

Intractable vomiting in an elderly patient is an emergency condition requiring prompt diagnosis and intervention. Acute gastric outlet obstruction due to gastric volvulus through Morgagni-type diaphragmatic hernia is an exceedingly rare cause of this nonspecific complaint. Our aim was to highlight that Morgagni hernia, although rare in adults, should be suspected in the appropriate clinical setting, and that a clue toward diagnosis often comes from routine chest and abdominal x-ray studies. In addition, we emphasize the atypical radiological findings and importance of emergency surgical intervention in such a case. We describe the case of a 78-year-old woman who presented to the Emergency Department with a 4-day history of intractable vomiting, and with no definitive clue to the diagnosis on examination. Her routine chest and abdomen x-ray studies suggested abnormal air-fluid level at right hemithorax, which prompted a computed tomography (CT) scan of the abdomen and an upper gastrointestinal contrast study. Gastric volvulus through a foramen of Morgagni was diagnosed and transthoracic reduction of the contents was performed, along with repair of the defect. A symptomatic Morgagni hernia in adults, although rare, can present with a variety of symptoms ranging from nonspecific complaints of bloating and indigestion to the more severe complaint of intestinal obstruction. Gastric volvulus and obstructive features are less frequently reported as acute complications of these hernias, which need early identification and intervention. Copyright © 2013 Elsevier Inc. All rights reserved.

Morgagni hernia presenting with lung consolidation unresponsive to ...

African Journals Online (AJOL)

Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm that allows the abdominal organs to push into the chest cavity. We report the case of a 15-month-old patient who presented with a non-resolving opacity on a chest radiograph despite extensive antibiotic treatment. A large anterior ...

Diaphragmatic crural eventration

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Sivakumar K

2008-01-01

Full Text Available Aim: We evaluated patients with gastric volvulus secondary to diaphragmatic pathology. Materials and Methods: Eight patients (5 males and 3 females presented to the author in a tertiary care center during 1997-2006 were analyzed in terms of age, sex, symptomatology, diagnosis and predisposing factors. Observations: Six had an acute presentation and rest had chronic symptomatology. The two patients who had total gangrene stomach died postoperatively and one patient died preoperatively due to aspiration. All the cases presented with acute symptoms had diaphragmatic pathology, and out of these, three cases had the specific entity, which is named as diaphragmatic crural eventration. Conclusions: Diaphragmatic crural eventration is characterized by the defective development of the right crus of diaphragm, and this is embryologically significant as the right crus and ligaments of the stomach develop from dorsal mesoesophagus and mesogastrium. The author recommends a closer look for this defect of diaphragm while operating a case of gastric volvulus.

Pulmonary hypoplasia-diaphragmatic hernia-anophthalmia-cardiac defect (PDAC) syndrome due to STRA6 mutations--what are the minimal criteria?

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Segel, Reeval; Levy-Lahad, Ephrat; Pasutto, Francesca; Picard, Elie; Rauch, Anita; Alterescu, Gheona; Schimmel, Michael S

2009-11-01

Microphthalmic syndrome 9 (OMIM601186) is a genetically and phenotypically variable condition, comprising anophthalmia, pulmonary hypoplasia, diaphragmatic hernia, and cardiac malformations (PDAC syndrome). Reported cases have all been associated with fetal/neonatal death or developmental delay. Recessive stimulated by retinoic acid gene 6 homolog (STRA6) mutations have recently been identified as the cause of cases of PDAC in which distinct, "bushy" eyebrows have been observed. We describe a patient with clinical anophthalmia, bushy eyebrows, patent ductus arteriosus, and normal development at age 30 months, who is a compound heterozygote for two novel STRA6 missense mutations. This patient's phenotype is consistent with the multisystemic malformations of PDAC syndrome, but is somewhat milder. This is the first living patient with compound heterozygous STRA6 mutations, which may explain her milder phenotype. We conclude that STRA6 analysis should be considered in all patients with clinical anophthalmia. Genetic counseling should be cautious with respect to long-term developmental outcomes. Copyright 2009 Wiley-Liss, Inc.

The MRI findings of a de Garengeot hernia.

LENUS (Irish Health Repository)

Halpenny, D

2012-03-01

The presence of the appendix within a femoral hernia is rare. It was first described by the French surgeon Jacques Croissant de Garengeot in 1731. This phenomenon accounts for 0.8-1% of all femoral hernias. Acute appendicitis occurring within a femoral hernia is even rarer and is difficult to diagnose pre-operatively. This type of hernia is termed a de Garengeot hernia. The ultrasonographic and CT imaging features of de Garengeot hernias have been described previously. We report a case of a 57-year-old female who presented with a painful right-sided groin mass. She underwent MRI of the inguinal region, which successfully diagnosed this rare hernia pre-operatively. To our knowledge, this is the first description of a de Garengeot hernia diagnosed using MRI.

Prenatally diagnosed 17q12 microdeletion syndrome with a novel association with congenital diaphragmatic hernia.

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Hendrix, Nancy W; Clemens, Michele; Canavan, Timothy P; Surti, Urvashi; Rajkovic, Aleksandar

2012-01-01

We describe the first reported case of a prenatally diagnosed and recently described 17q12 microdeletion syndrome. The fetus was noted to have a congenital diaphragmatic hernia (CDH), echogenic kidneys and cystic left lung on prenatal ultrasound. The patient underwent amniocentesis which resulted in a normal fluorescence in-situ hybridization and karyotype. An oligonucleotide microarray was then performed which demonstrated a 1.4-Mb deletion within the 17q12 region. The deletion caused haploinsufficiency for 17 genes, including AATF, ACACA, DDX52, DUSP14, GGNBP2, HNF-1B, LHX1, PIGW, SYNRG, TADA2A, and ZNHIT3. The deleted region on 17q12 is similar in size and gene content to previously reported 17q12 microdeletion syndromes, which have a minimal critical region of 1.52 Mb. The newly described 17q12 microdeletion syndrome has been associated with MODY5 (maturity-onset of diabetes of the young type 5), cystic renal disease, pancreatic atrophy, liver abnormalities, cognitive impairment and structural brain abnormalities. CDH has not been previously described with the 17q12 microdeletion syndrome. We hypothesize that CDH is part of the spectrum of this syndrome and likely not detected postnatally due to high prenatal mortality. Copyright © 2011 S. Karger AG, Basel.

Amyand's hernia with appendicitis in the children: A delayed diagnosis

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Asma Jabloun

2016-10-01

Full Text Available The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. It is an uncommon and rare condition estimated to be found in approximately 1 % of hernia. However, in just 0.08 %, the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix, and is most often misdiagnosed as an incarcerated inguinal hernia. As such, it is rarely recognized prior to surgical exploration. We report a case of Amyand’s hernia in a 2-month-old male, who presented as a right-sided congenital hernia with pain in the right groin. He underwent herniotomy, which revealed that the hernia sac containing elongated inflamed appendix appeared with some adhesions to sac, lying in the inguinal canal.

Laparoscopic management of right paraduodenal hernia along with ...

African Journals Online (AJOL)

laparoscopic repair of a right PDH and the third in the pediatric age ... perinephric space laterally to open the hernia defect widely. ... the operative approach in this situation. Only five ... bilateral inguinal, and epigastric pain associated with.

Amyand’s Hernia – Vermiform Appendix in an Inguinal Hernia: A Rare Finding

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Prakash Kumar Sahoo

2017-10-01

Full Text Available A variety of surprises may spring up when the sac is opened in an inguinal hernia. Omentum, bowel diverticulum, ovary, fallopian tube, urinary bladder, large bowel, Meckel’s diverticulum or foreign bodies being the varied contents of a hernia sac. The presence of vermiform appendix in the hernia sac in an inguinal hernia is a rare finding. This condition has been named as “Amyand’s Hernia” in the honour of an English surgeon, Claudius Amyand. A diagnosis preoperatively is difficult and is most often made intraoperatively. We report here a 52-year-old patient who presented with acute intestinal obstruction due to an obstructed right sided inguinal hernia. A diagnosis of Amyand’s hernia was confirmed when on exploration appendix along with a part of ascending colon was found to be content of the sac along with a few loops of small bowel. The contents were reduced after checking the viability and Bassini’s repair was done. The patient had an uneventful postoperative period.

Use of milrinone to treat cardiac dysfunction in infants with pulmonary hypertension secondary to congenital diaphragmatic hernia: a review of six patients.

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Patel, Neil

2012-01-01

Pulmonary hypertension and secondary cardiac dysfunction are important contributors of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). Milrinone, a phosphodiesterase-3 inhibitor, may be useful in this setting for its combined actions as a pulmonary vasodilator and to improve systolic and diastolic function. This study aimed to assess the effects of milrinone on cardiac function and pulmonary artery pressure in infants with CDH. A retrospective review of echocardiograms performed on infants with CDH who received milrinone was performed. Tissue Doppler imaging velocities were used to assess systolic and diastolic function. Pulmonary artery pressure was assessed from the pattern and velocity of ductal shunting. Six infants with CDH and severe pulmonary hypertension were identified. Systolic and diastolic myocardial velocities were reduced in the right ventricle (RV) and interventricular septum (IVS) at baseline. In the 72 h after commencement of milrinone, there was a significant increase in early diastolic myocardial velocities in the RV, accompanied by increasing systolic velocities in the RV and IVS. Oxygenation index was significantly reduced, blood pressure unchanged, and ductal shunt velocity minimally altered over the same time period. Milrinone use was associated with an improvement in systolic and diastolic function in the RV, corresponding to an improvement in clinical status. Copyright © 2012 S. Karger AG, Basel.

Thoracic and diaphragmatic endometriosis: Single-institution experience using a novel broadened diagnostic criteria

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Larraín, Demetrio; Suárez, Francisco; Braun, Hernán; Chapochnick, Javier; Diaz, Lidia; Rojas, Iván

2018-06-05

To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the “thoracic endometriosis syndrome (TES)” to define cases. We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Five women were included. Two cases were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, one due to new-onset diaphragmatic hernia. One patient had not thoracic symptoms, and diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up all patients remain asymptomatic. Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved to tertiary referral centers.

Standardization of pulmonary ventilation technique using volume-controlled ventilators in rats with congenital diaphragmatic hernia

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Rodrigo Melo Gallindo

Full Text Available OBJECTIVE: To standardize a technique for ventilating rat fetuses with Congenital Diaphragmatic Hernia (CDH using a volume-controlled ventilator. METHODS: Pregnant rats were divided into the following groups: a control (C; b exposed to nitrofen with CDH (CDH; and c exposed to nitrofen without CDH (N-. Fetuses of the three groups were randomly divided into the subgroups ventilated (V and non-ventilated (N-V. Fetuses were collected on day 21.5 of gestation, weighed and ventilated for 30 minutes using a volume-controlled ventilator. Then the lungs were collected for histological study. We evaluated: body weight (BW, total lung weight (TLW, left lung weight (LLW, ratios TLW / BW and LLW / BW, morphological histology of the airways and causes of failures of ventilation. RESULTS: BW, TLW, LLW, TLW / BW and LLW / BW were higher in C compared with N- (p 0.05. The morphology of the pulmonary airways showed hypoplasia in groups N- and CDH, with no difference between V and N-V (p <0.05. The C and N- groups could be successfully ventilated using a tidal volume of 75 ìl, but the failure of ventilation in the CDH group decreased only when ventilated with 50 ìl. CONCLUSION: Volume ventilation is possible in rats with CDH for a short period and does not alter fetal or lung morphology.

Transient megaoesophagus and oesophagitis following diaphragmatic rupture repair in a cat.

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Joseph, Rotem; Kuzi, Sharon; Lavy, Eran; Aroch, Itamar

2008-07-01

A 6-month-old domestic shorthair female cat was presented with suspected diaphragmatic hernia (DH) that was later confirmed by thoracic radiography. The cat underwent exploratory celiotomy with a diaphragmatic rupture (DR) repair and recovered. Six days later, it was represented with vomiting and anorexia. Megaoesophagus (MO) and gastric dilatation were diagnosed by contrast radiography. A second celiotomy revealed no abnormalities and gastropexy was performed. Endoscopy demonstrated MO, oesophagitis and gastro-oesophageal reflux. MO persisted for several weeks and was an unexpected complication as no association between DR (or DH) and MO has never been described in the veterinary literature. The cat was treated medically with aggressive prokinetic and antacid therapy along with prolonged temporary oesophageal diversion (percutaneous endoscopic gastrostomy tube) with an excellent outcome.

Mesh Inguinal Hernia Repair and Appendectomy in the Treatment of Amyand’s Hernia with Non-Inflamed Appendices

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Emin Kose

2017-01-01

Full Text Available Amyand’s hernia is defined as protrusion of the vermiform appendix in an inguinal hernia sac. It is a rare entity with variable clinical presentation from normal vermiform appendix to abscess formation due to perforation of acute appendicitis. Although surgical treatment includes appendectomy and hernia repair, appendectomy in the absence of an inflamed appendix and use of a mesh in cases of appendectomy remain to be controversial. The aim of this study was to review the experience of mesh inguinal hernia repair plus appendectomy performed for Amyand’s hernia with noninflamed appendices. There were five male patients with a mean age of 42.4 ± 16.1 years in this retrospective study in which Amyand’s hernia was treated with mesh inguinal hernia repair plus appendectomy for noninflamed appendices. Patients with acute appendicitis and perforated vermiform appendix were excluded. There were four right sided and one bilateral inguinal hernia. Postoperative courses were uneventful. During the follow-up period (14.0 ± 7.7 months, there was no inguinal hernia recurrence. Mesh inguinal hernia repair with appendectomy can be performed for Amyand’s hernia in the absence of acute appendicitis. However, presence of fibrous connections between the vermiform appendix and the surrounding hernia sac may be regarded as a parameter to perform appendectomy.

Amyand’s Hernia: Rare Presentation of a Common Ailment

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Sanjeev Singhal

2015-01-01

Full Text Available Inguinal hernia with vermiform appendix as content is known as Amyand’s hernia. It is a rare entity but we encountered four cases within six months. A 52-year-old female had high grade fever and evidence of inflammatory pathology involving the ileocaecal region. She was initially managed conservatively and subsequently underwent exploratory laparatomy. The appendix was perforated and herniating in the inguinal canal. Appendectomy was done with herniorrhaphy without mesh placement. A 74-year-old male with bilateral inguinal hernia, of which, the right side was more symptomatic, underwent open exploration. Operative findings revealed a lipoma of the sac and a normal appearing appendix as content. Contents were reduced without appendectomy and mesh hernioplasty was performed. A 63-year-old male with an obstructed right sided hernia underwent emergency inguinal exploration which revealed edematous caecum and appendix as content without any inflammation. Contents were reduced without any resection. Herniorrhaphy was performed without mesh placement. A 66-year-old male with an uncomplicated right inguinal hernia underwent elective surgery. The sac revealed an appendix with adhesions at the neck. Contents were reduced after adhesiolysis and hernioplasty was performed with mesh placement. Emphasis is made to the rarity of disease, variation in presentation, and difference in treatment modalities depending upon the state of appendix.

Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair

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Hagelstein, Claudia; Weidner, Meike; Schoenberg, Stefan O.; Buesing, Karen A.; Neff, K.W. [University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim (Germany); Zahn, Katrin [University of Heidelberg, Department of Pediatric Surgery, University Medical Center Mannheim, Mannheim (Germany); Weiss, Christel [University of Heidelberg, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Mannheim (Germany); Schaible, Thomas [University of Heidelberg, Department of Pediatrics, University Medical Center Mannheim, Mannheim (Germany)

2015-01-15

To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV). The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair. Seventy-seven percent (77 %) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23 % (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2 %) than patients with primary repair (40.8 ± 13.8 %, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20 %, 92 % of the patients required patch repair, compared to only 24 % with an o/e MR-FLV of 60 %. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827). Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy. (orig.)

Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

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Aissa, Sana; Benzarti, Wafa; Alimi, Faouzi; Gargouri, Imen; Salem, Halima Ben; Aissa, Amène; Fathallah, Khadija; Abdelkade, Atef Ben; Alouini, Rafika; Garrouche, Abdelhamid; Hayoun, Abdelaziz; Abdelghani, Ahmed; Benzarti, Mohamed

2017-01-01

Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair

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Weidner, M.; Hagelstein, C.; Schoenberg, S.O.; Neff, K.W. [University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Zoellner, F.G.; Schad, L.R. [Heidelberg University, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Mannheim (Germany); Zahn, K. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Department of Pediatric Surgery, Mannheim (Germany); Schaible, T. [University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Pediatrics, Mannheim (Germany)

2014-10-15

Congenital diaphragmatic hernia (CDH) leads to lung hypoplasia. Using dynamic contrast-enhanced (DCE) MR imaging, lung perfusion can be quantified. As MR perfusion values depend on temporal resolution, we compared two protocols to investigate whether ipsilateral lung perfusion is impaired after CDH, whether there are protocol-dependent differences, and which protocol is preferred. DCE-MRI was performed in 36 2-year old children after CDH on a 3 T MRI system; protocol A (n = 18) based on a high spatial (3.0 s; voxel: 1.25 mm{sup 3}) and protocol B (n = 18) on a high temporal resolution (1.5 s; voxel: 2 mm{sup 3}). Pulmonary blood flow (PBF), pulmonary blood volume (PBV), mean transit time (MTT), and peak-contrast-to-noise-ratio (PCNR) were quantified. PBF was reduced ipsilaterally, with ipsilateral PBF of 45 ± 26 ml/100 ml/min to contralateral PBF of 63 ± 28 ml/100 ml/min (p = 0.0016) for protocol A; and for protocol B, side differences were equivalent (ipsilateral PBF = 62 ± 24 vs. contralateral PBF = 85 ± 30 ml/100 ml/min; p = 0.0034). PCNR was higher for protocol B (30 ± 18 vs. 20 ± 9; p = 0.0294). Protocol B showed higher values of PBF in comparison to protocol A (p always <0.05). Ipsilateral lung perfusion is reduced in 2-year old children following CDH repair. Higher temporal resolution and increased voxel size show a gain in PCNR and lead to higher perfusion values. Protocol B is therefore preferred. (orig.)

Amyand′s hernia masquerading as a strangulated inguinal hernia: A case report and literature review

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Shahbaz Habib Faridi

2014-01-01

Full Text Available We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyand′s hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.

Are all pulmonary hypoplasias the same? A comparison of pulmonary outcomes in neonates with congenital diaphragmatic hernia, omphalocele and congenital lung malformation.

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Akinkuotu, Adesola C; Sheikh, Fariha; Cass, Darrell L; Zamora, Irving J; Lee, Timothy C; Cassady, Christopher I; Mehollin-Ray, Amy R; Williams, Jennifer L; Ruano, Rodrigo; Welty, Stephen E; Olutoye, Oluyinka O

2015-01-01

Patients with congenital diaphragmatic hernias (CDH), omphaloceles, and congenital lung malformations (CLM) may have pulmonary hypoplasia and experience respiratory insufficiency. We hypothesize that given equivalent lung volumes, the degree of respiratory insufficiency will be comparable regardless of the etiology. Records of all fetuses with CDH, omphalocele, and CLM between January 2000 and June 2013 were reviewed. MRI-based observed-to-expected total fetal lung volumes (O/E-TFLV) were calculated. An analysis of outcomes in patients with O/E-TFLV between 40% and 60%, the most inclusive range, was performed. 285 patients were evaluated (161, CDH; 24, omphalocele; 100, CLM). Fetuses with CDH had the smallest mean O/E-TFLV. CDH patients were intubated for longer and had a higher incidence of pulmonary hypertension. Fifty-six patients with the three diagnoses had an O/E-TFLV of 40%-60%. The need for ECMO, supplemental oxygen at 30days of life, and 6-month mortality were similar among groups. CDH patients had a significantly longer duration of intubation and higher incidence of pulmonary hypertension than the other two diagnoses. Given equivalent lung volumes (40%-60% of expected), CDH patients require more pulmonary support initially than omphalocele and CLM patients. In addition to lung volumes, disease-specific factors, such as pulmonary hypertension in CDH, also contribute to pulmonary morbidity and overall outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

Intrathoracic Caecal Perforation Presenting as Dyspnea

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Vincent Granier

2010-01-01

Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

A case of Bochdalek hernia in adult misdiagnosed as pulmonary tuberculosis

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Pradosh Kumar Sarangi

2017-01-01

Full Text Available Bochdalek hernias are congenital defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Usually it manifests in the neonatal period and occasionally in childhood. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. Patients are initially investigated and treated for other diseases, therefore diagnosis is purely incidental. Herein, we are reporting a case of symptomatic Bochdalek hernia in an 18-year-old female misdiagnosed as pulmonary tuberculosis and treated accordingly, but with no improvement. This case illustrates importance of high index of clinical suspicion and role of computed tomography in avoiding misdiagnosis and occurrence of serious complication if not treated early. [J Med Allied Sci 2017; 7(1.000: 59-63

FRACTURES OF THE RIBS AND THE DIAPHRAGMATIC RUPTURE WITH A FORMATION OF THE TRANSDIAPHRAGMATIC INTERCOSTAL HERNIA AS A RESULT OF SEVERE COUGHING (CLINICAL OBSERVATION WITH A REVIEW OF THE LITERATURE

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S. N. Danielyan

2014-01-01

Full Text Available ABSTRACT. Severe coughing might lead to development of a number of complications, including the diaphragmatic rupture and the ribs fractures. The report contains two similar rare clinical cases: male patients aged 48 and 74 years with transdiaphragmatic intercostal thoracic wall hernia after the rupture of the left half of the diaphragm and ribs fractures as a result of violent coughing. Both patients had a late diagnosis of injuries. Surgical therapy was performed via thoracotomy access using a mesh implant. histological study of the rib in the damaged area in one case detected fibrous osteodysplasia. The review of literature on this rare type of injury was analyzed. 

Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology

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Michael Leshen

2016-01-01

Full Text Available Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired.

Predictors of prognosis in neonates with congenital diaphragmatic hernia: experience of 12 years

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Catarina Granjo Morais

2017-01-01

Full Text Available Introduction: Congenital diaphragmatic hernia (CDH is a severe malformation, displaying relevant mortality and morbidity rates in newborns.Aim: To characterize clinically and demographically all neonatal cases of CDH admitted to a level III Neonatal Intensive Care Unit during a 12-year period and to evaluate the predictive value of baseline characteristics on mortality and morbidity at discharge.Methods: Maternal/infant clinical and electronic records were ret-rospectively reviewed. All neonates with posterolateral CDH admitted between January 2003 and December 2014 were included.Results: Fifty-three newborns were included. Overall mortality during hospitalization was 22/53 (41.5%. Clinical characteristics associated with mortality were the presence of intrathoracic liver (p = 0.005, intrathoracic stomach (p = 0.015, elevated arterial pCO2 or lower pH values at admission (respectively, p = 0.001 and p < 0.001, pre-ductal oxygen saturation < 85% at admission (p = 0.012 and surgical repair with prosthetic patch (p = 0.041. Morbidity at discharge was reported in 7 (22.6% survivors. Stomach herniation and sepsis were associated with higher morbidity (respectively, p = 0.012 and p = 0.029. In a logistic regression, patch repair was the only variable with predictive value for death during hospitalization, with an odds ratio (OR of 15 (95% CI 0.98-228.9, and intrathoracic stomach was a predictor of morbidity at discharge (OR = 15.7, 95% CI 1.4-174.2.Conclusion: Structural characteristics, namely defect size and presence of intrathoracic stomach, remain the primary determinants of neonatal prognosis in CDH. Although post-natal approaches have progressively proven their value in increasing survival and improving management of high-risk cases, future researches should continue focusing on the definition of foetal anatomical markers of severity and prenatal treatment of CDH.

Celiac artery compression syndrome with bilateral Bochdalek hernia

International Nuclear Information System (INIS)

Kara, K.; Verim, S.; Bozkurt, Y.; Tasar, M.

2012-01-01

Full text: Introduction: Celiac artery compression syndrome or median arcuate ligament syndrome is rare and controversial condition. The definition of the syndrome relies on a combination of both clinical and radiographic features. It typically occurs in young patients, who may present with epigastric pain and weight loss. Bochdalek hernia is the most common congenital diaphragmatic hernia in adults. Bilaterality of this pathology is rare. There are not many reports about the associated pathologies to Bochdalek hernia. Objectives and tasks: We aimed to demonstrate the computed tomography (CT) angiography findings of celiac artery compression syndrome with Bochdalek hernia that has detected incidentally. Materials and methods: A CT angiography was performed to 32-year-old patient having postphelebitic syndrome for the possible diagnosis as pulmonary embolus. Results: At the imaging pulmonary arteries and the branches were normal. Celiac artery compression syndrome with Bochdalek Hernia was detected incidentally. A %75 stenosis at the origin of celiac artery and post stenotic dilatation after the stenosis was seen due to the compression. A poster medial defect at the diaphragm was seen as an additional finding for the cause of Bochdalek hernia. Conclusion: Many incidental finding can be detected at vascular and non vascular area in the routine CT angiography imaging. The pathologies like celiac artery compression syndrome and congenital diaphragm pathologies can be detected easily at CT angiography method

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

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Thiam, Ousmane; Konate, Ibrahima; Gueye, Mohamadou Lamine; Toure, Alpha Omar; Seck, Mamadou; Cisse, Mamadou; Diop, Balla; Dirie, Elias Said; Ka, Ousmane; Thiam, Mbaye; Dieng, Madieng; Dia, Abdarahmane; Toure, Cheikh Tidiane

2016-01-01

Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions

Aggressive Surgical Management of Congenital Diaphragmatic Hernia: Worth the Effort?: A Multicenter, Prospective, Cohort Study.

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Harting, Matthew T; Hollinger, Laura; Tsao, Kuojen; Putnam, Luke R; Wilson, Jay M; Hirschl, Ronald B; Skarsgard, Erik D; Tibboel, Dick; Brindle, Mary E; Lally, Pamela A; Miller, Charles C; Lally, Kevin P

2018-05-01

The objectives of this study were (i) to evaluate infants with congenital diaphragmatic hernia (CDH) that do not undergo repair, (ii) to identify nonrepair rate by institution, and (iii) to compare institutional outcomes based on nonrepair rate. Approximately 20% of infants with CDH go unrepaired and the threshold to offer surgical repair is variable. Data were abstracted from a multicenter, prospectively collected database. Standard clinical variables, including repair (or nonrepair), and outcome were analyzed. Institutions were grouped based on volume and rate of nonrepair. Preoperative mortality predictors were identified using logistic regression, expected mortality for each center was calculated, and observed /expected (O/E) ratios were computed for center groups and compared by Kruskal-Wallis ANOVA. A total of 3965 infants with CDH were identified and 691 infants (17.5%) were not repaired. Nonrepaired patients had lower Apgar scores (P HiLo = 5.1-16.7% and HiHi = 17.6-38.5%), leaving 3 groups: HiLo, HiHi, and Lo. Predictors of mortality were lower birth weight, lower Apgar scores, prenatal diagnosis, and presence of congenital anomalies. O/E ratios for mortality in the HiLo, HiHi, and Lo groups were 0.81, 0.94, and 1.21, respectively (P HiLo centers have 2.73 (2.4-3.1, 95% confidence interval) survivors beyond expectation. There are significant differences between repaired and nonrepaired CDH infants and significant center variation in rate of nonrepair exists. Aggressive surgical management, leading to a low rate of nonrepair, is associated with improved risk-adjusted mortality.

Parálisis diafragmática bilateral. Presentación de un caso Bilateral diaphragmatic paralysis

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Jorge Carnot Pereira

2012-04-01

Full Text Available La parálisis diafragmática bilateral es una entidad muy infrecuente en la clínica, debido a diferentes entidades con capacidad de lesionar el nervio frénico. El compromiso respiratorio que produce requiere cuidado especializado. Este es el primer caso reportado en nuestra literatura a consecuencia de hernias cervicales múltiples. Se presenta un caso de un paciente de 43 años, con antecedentes de salud, exatleta de alto rendimiento, que ingresó en nuestro servicio, con disnea de 5 meses de evolución, que aumentó progresivamente en intensidad hasta mantenerlo en ortopnea constante, fue estudiado exhaustivamente hasta llegar a diagnostico definido y derivarlo al servicio de Neurocirugía para su solución definitiva. La importancia del tema que se presenta es que se describe una presentación rara de parálisis diafragmática bilateral, a consecuencia de hernias discales cervicales múltiples.Bilateral diaphragmatic paralysis is a rare condition in clinical practice due to different entities that can damage phrenic nerve. The resulting respiratory compromise requires medical special care. This is the first case reported in our medical literature caused by multiple cervical hernias. A 43 year-old patient having health history, high performance ex-athlete, admitted in the service with 5-month evolution of dyspnea which progressively increased in intensity up to maintain him in permanent orthopnea, thorough studies were conducted to the definite diagnosis and he was transferred to Neurosurgery Service to a definite solution. A rare presentation of a bilateral diaphragmatic paralysis resulting from multiple cervical hernias gives importance to the topic.

Incidental Hiatal Hernia Detected with Meckel's Scintigraphy

International Nuclear Information System (INIS)

Aksoy, Tamer; Kiratli, Pinar Ozgen

2011-01-01

Congenital hiatal hernia (CHH) in children is a very rare condition that occurs in about 1 in every 2,000 to 5,000 live births, with a male to female ratio of 2:3. In 97% of cases the anomaly is unilateral with a left side preponderance. The hernia content can include the stomach, bowel loops, spleen or part of the liver. CHH may remain asymptomatic or induce only nonspecific gastro intestinal and/or thoracic symptoms. The symptomatology og these patients is usually non specific, in the form of repeated attacks of chest infection and/or recurrent vomiting, but can be associated with serious complications such as intrathoracic gastric volvulus with incarceration and strangulation. Because of the gastroesophageal reflux, linear ulcerations on the esophageal mucosa might occur and cause intermittent bleeding. Plan chest radiographs, AP and lateral, may raise a suspicion of the condition, while upper gastrointestinal contrast series are diagnostic. The treatment is surgery consisting of excision of the hernial sac after reducing the stomach and repair of the diaphragmatic defect by tightening the crura of the esophageal hiatus. If the defect is large and associated with displacement of the gastroesophageal junction (GEJ) into the thorax, adding an anti reflux procedure to the repair is appropriate. This can be achieved transabdominally either by laparotomy or laparoscopically. To the best of our knowledge, this is the second case diagnosed with Meckel's scintigraphy.

Incidental right Bochdalek hernia with interruption of the inferior ...

African Journals Online (AJOL)

2014-05-30

May 30, 2014 ... Case Report doi:10.4102/sajr.v18i1.592 http://sajr.org.za. Incidental right Bochdalek hernia with interruption of the inferior vena cava and hepatic venous collateral continuation: A case report. Authors: Farzanah I. Ismail1. Rule Human2. Anith Chacko1. Parmanand Naran2. Samia Ahmad1. Siraj Ellemdin2.

Abordagem ventilatória protetora no tratamento da hérnia diafragmática congênita Gentle ventilatory approach for the treatment of congenital diaphragmatic hernia

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Felipe de Souza Rossi

2008-12-01

Full Text Available OBJETIVO: Descrever a evolução de recém-nascidos com diagnóstico de hérnia diafragmática congênita admitidos na Unidade de Terapia Intensiva Neonatal de um hospital privado de nível terciário, no qual aplicou-se uma estratégia ventilatória protetora. MÉTODOS: Coorte histórica com análise de prontuários de pacientes portadores de hérnia diafragmática congênita, admitidos de junho de 2001 a julho de 2006. Avaliaram-se dados referentes ao recém-nascido (índices prognósticos antenatais, peso ao nascimento, idade gestacional, sexo, dados da reanimação e estabililização pré-operatória, cuidados pós-operatórios e taxa de sobrevida. RESULTADOS: Oito neonatos tiveram diagnóstico de hérnia diafragmática congênita. O peso variou entre 2,38 e 3,45kg e a idade gestacional, entre 36 e 39 semanas; cinco deles eram do sexo masculino. Todos foram intubados em sala de parto até o final do primeiro minuto de vida. A correção cirúrgica ocorreu entre o segundo e o sexto dias de vida e, em quatro pacientes, houve necessidade do uso de patch. Uma estratégia ventilatória protetora foi utilizada em seis neonatos, com dados gasométricos visando PaO2 pré-ductal normal e tolerando-se hipercapnia (PaCO2 50 a 60mmHg. A extubação ocorreu entre o primeiro e o 12ºdias do pós-operatório, com exceção de um paciente. Seis recém-nascidos receberam alta, em média, com 30 dias de vida (19 a 55 dias. A sobrevida foi de 75%. CONCLUSÕES: A sistematização do cuidado de pacientes com hérnia diafragmática congênita pode garantir, em nosso meio, uma sobrevida comparável aos principais centros mundiais que lidam com a doença.OBJECTIVE: To describe the clinical evolution of newborns with congenital diaphragmatic hernia admitted to neoretal Intensive Care Unit of a tertiary private hospital and treated with a gentle ventilatory approach. METHODS: Analysis of charts of patients born between June 2001 and July 2006. The following data

VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen

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Sbragia, L. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Nassr, A.C.C. [Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, SP, Brasil, Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, SP (Brazil); Gonçalves, F.L.L. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Schmidt, A.F. [Pediatrics House Office, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH, USA, Pediatrics House Office, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Zuliani, C.C. [Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP (Brazil); Garcia, P.V. [Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP (Brazil); Gallindo, R.M. [Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Pereira, L.A.V. [Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP (Brazil)

2014-02-17

Changes in vascular endothelial growth factor (VEGF) in pulmonary vessels have been described in congenital diaphragmatic hernia (CDH) and may contribute to the development of pulmonary hypoplasia and hypertension; however, how the expression of VEGF receptors changes during fetal lung development in CDH is not understood. The aim of this study was to compare morphological evolution with expression of VEGF receptors, VEGFR1 (Flt-1) and VEGFR2 (Flk-1), in pseudoglandular, canalicular, and saccular stages of lung development in normal rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups (n=20 fetuses each) of four different gestational days (GD) 18.5, 19.5, 20.5, 21.5: external control (EC), exposed to olive oil (OO), exposed to 100 mg nitrofen, by gavage, without CDH (N-), and exposed to nitrofen with CDH (CDH) on GD 9.5 (term=22 days). The morphological variables studied were: body weight (BW), total lung weight (TLW), left lung weight, TLW/BW ratio, total lung volume, and left lung volume. The histometric variables studied were: left lung parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2 expression were determined by Western blotting. The data were analyzed using analysis of variance with the Tukey-Kramer post hoc test. CDH frequency was 37% (80/216). All the morphological and histometric variables were reduced in the N- and CDH groups compared with the controls, and reductions were more pronounced in the CDH group (P<0.05) and more evident on GD 20.5 and GD 21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a decrease in VEGFR1 and VEGFR2 expression.

VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen

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L. Sbragia

2014-02-01

Full Text Available Changes in vascular endothelial growth factor (VEGF in pulmonary vessels have been described in congenital diaphragmatic hernia (CDH and may contribute to the development of pulmonary hypoplasia and hypertension; however, how the expression of VEGF receptors changes during fetal lung development in CDH is not understood. The aim of this study was to compare morphological evolution with expression of VEGF receptors, VEGFR1 (Flt-1 and VEGFR2 (Flk-1, in pseudoglandular, canalicular, and saccular stages of lung development in normal rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups (n=20 fetuses each of four different gestational days (GD 18.5, 19.5, 20.5, 21.5: external control (EC, exposed to olive oil (OO, exposed to 100 mg nitrofen, by gavage, without CDH (N-, and exposed to nitrofen with CDH (CDH on GD 9.5 (term=22 days. The morphological variables studied were: body weight (BW, total lung weight (TLW, left lung weight, TLW/BW ratio, total lung volume, and left lung volume. The histometric variables studied were: left lung parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2 expression were determined by Western blotting. The data were analyzed using analysis of variance with the Tukey-Kramer post hoc test. CDH frequency was 37% (80/216. All the morphological and histometric variables were reduced in the N- and CDH groups compared with the controls, and reductions were more pronounced in the CDH group (P<0.05 and more evident on GD 20.5 and GD 21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a decrease in VEGFR1 and VEGFR2 expression.

VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen

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Sbragia, L.; Nassr, A.C.C.; Gonçalves, F.L.L.; Schmidt, A.F.; Zuliani, C.C.; Garcia, P.V.; Gallindo, R.M.; Pereira, L.A.V.

2014-01-01

Changes in vascular endothelial growth factor (VEGF) in pulmonary vessels have been described in congenital diaphragmatic hernia (CDH) and may contribute to the development of pulmonary hypoplasia and hypertension; however, how the expression of VEGF receptors changes during fetal lung development in CDH is not understood. The aim of this study was to compare morphological evolution with expression of VEGF receptors, VEGFR1 (Flt-1) and VEGFR2 (Flk-1), in pseudoglandular, canalicular, and saccular stages of lung development in normal rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups (n=20 fetuses each) of four different gestational days (GD) 18.5, 19.5, 20.5, 21.5: external control (EC), exposed to olive oil (OO), exposed to 100 mg nitrofen, by gavage, without CDH (N-), and exposed to nitrofen with CDH (CDH) on GD 9.5 (term=22 days). The morphological variables studied were: body weight (BW), total lung weight (TLW), left lung weight, TLW/BW ratio, total lung volume, and left lung volume. The histometric variables studied were: left lung parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2 expression were determined by Western blotting. The data were analyzed using analysis of variance with the Tukey-Kramer post hoc test. CDH frequency was 37% (80/216). All the morphological and histometric variables were reduced in the N- and CDH groups compared with the controls, and reductions were more pronounced in the CDH group (P<0.05) and more evident on GD 20.5 and GD 21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a decrease in VEGFR1 and VEGFR2 expression

Diaphragmatic thickness ratio (inspiratory/expiratory) as a diagnostic method of diaphragmatic palsy associated with interescalene block.

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López Escárraga, V M; Dubos España, K; Castillo Bustos, R H; Peidró, L; Sastre, S; Sala-Blanch, X

2018-02-01

Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. We designed an observational study in 22 patients scheduled for shoulder arthroscopy. Spirometry was performed (criteria of phrenic paresis was a decrease in FVC and FEV1 ≥20%). Ultrasound apposition zone was assessed in anterior axillary line and diaphragmatic displacement was evaluated on inspiration and expiration (number of intercostal spaces; phrenic paresis considered a reduction ≥25%) and thickness of the diaphragm muscle (a phrenic paresis was considered an index block at C5-C6 with 20ml of 0.5% ropivacaine. Twenty-one patients (95%) presented phrenic nerve block according to one or more of the methods used. One patient did not show any symptoms or signs suggestive of phrenic paralysis and was excluded. All the patients presented phrenic paresis based on the diaphragmatic thickness index, with the pre-block index being 1.8±0.5 and post-block of 1.05±0.06 (Pblock (from 1.9±0.5 intercostal spaces to 0.5±0.3; Pblock. This index does not require a baseline pre-assessment. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Prognostic indicators for perioperative survival after diaphragmatic herniorrhaphy in cats and dogs: 96 cases (2001-2013).

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Legallet, Claire; Thieman Mankin, Kelley; Selmic, Laura E

2017-01-07

To determine associations between perioperative mortality after surgery for traumatic diaphragmatic hernia, medical records of 17 cats and 79 dogs that underwent diaphragmatic herniorrhaphy were reviewed. The combined perioperative survival rate was 81.3% (88.2% in cats and 79.8% in dogs). Data from acute and chronic cases was assessed separately. Of the acute cases (12 cats and 48 dogs), 10 cats (83.3%) and 38 dogs (79.2%) survived to discharge. Of the chronic cases (5 cats and 31 dogs), 5 cats (100%) and 25 dogs (80.6%) survived to discharge. The time between trauma and surgery, trauma and admission, and admission and surgery were not associated with survival. For cats and dogs, increased duration of anesthesia and surgical procedure were associated with increased mortality (P = 0.0013 and 0.004, respectively). Animals with concurrent soft tissue injuries had a 4.3 times greater odds of mortality than those without soft tissue injury (P = 0.01). Animals with concurrent soft tissue and orthopedic injuries had a 7.3 times greater odds of mortality than those without soft tissue and orthopedic injuries (P = 0.004). Animals that were oxygen dependent had a 5.0 times greater odds of mortality than those that were not (P = 0.02). No other variables were significantly associated with survival. For cats and dogs that underwent surgery for traumatic diaphragmatic hernia, increased anesthetic duration, increased duration of surgical procedure, concurrent soft tissue injuries, concurrent soft tissue and orthopedic injuries, and perioperative oxygen dependence were associated with increased mortality.

Diaphragmatic herniation following donor hepatectomy for living donor liver transplantation: a serious complication not given due recognition.

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Lochan, Rajiv; Saif, Rehan; Ganjoo, Naveen; Sakpal, Mallikarjun; Panackal, Charles; Raja, Kaiser; Reddy, Jayanth; Asthana, Sonal; Jacob, Mathew

2017-11-01

A clear appreciation of benefits and risks associated with living donor hepatectomy is important to facilitate counselling for the donor, family, and recipient in preparation for living donor liver transplant (LDLT). We report a life-threatening complication occurring in one of our live liver donors at 12 weeks following hemi-liver donation. We experienced five donor complications among our first 50 LDLT: Clavien Grade 1, n=1; Clavien grade 2, n=3; and Clavien grade 3B, n=1. The one with Clavien grade 3B had a life-threatening diaphragmatic hernia occurring 12 weeks following hepatectomy. This was promptly recognized and emergency surgery was performed. The donor is well at 1-year follow-up. Here we provide a review of reported instances of diaphragmatic hernia following donor hepatectomy with an attempt to elucidate the pathophysiology behind such occurrence. Life-threatening donor risk needs to be balanced with recipient benefit and risk on a tripartite basis during the counselling process for LDLT. With increasing use of LDLT, we need to be aware of such life-threatening complication. Preventive measures in this regard and counselling for such complication should be incorporated into routine work-up for potential live liver donor.

Neurotrophins expression is decreased in lungs of human infants with congenital diaphragmatic hernia

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O'Hanlon LD

2014-02-01

Full Text Available Lynn D O'Hanlon, Sherry M Mabry, Ikechukwu I EkekezieChildren's Mercy Hospitals/University of Missouri-Kansas City School of Medicine, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Kansas City, MO, USAObjectives: To evaluate neurotrophin (NT (nerve growth factor [NGF], NT-3, and brain-derived neurotrophic factor [BDNF] expression in autopsy lung tissues of human congenital diaphragmatic hernia (CDH infants versus that of infants that expired with: 1 "normal" lungs (controls; 2 chronic lung disease (CLD; and 3 pulmonary hypertension (PPHN.Hypothesis: NT expression will be significantly altered in CDH lung tissue compared with normal lung tissue and other neonatal lung diseases.Study design: Immunohistochemical studies for NT proteins NGF, BDNF, and NT-3 were applied to human autopsy neonatal lung tissue samples.Subject selection: The samples included a control group of 18 samples ranging from 23-week gestational age to term, a CDH group of 15 samples, a PPHN group of six samples, and a CLD group of 12 samples.Methodology: The tissue samples were studied, and four representative slide fields of alveoli/saccules and four of bronchioles were recorded from each sample. These slide fields were then graded (from 0 to 3 by three blinded observers for intensity of staining.Results: BDNF, NGF, and NT-3 immunostaining intensity scores were significantly decreased in the CDH lung tissue (n=15 compared with normal neonatal lung tissue (n=18 (P<0.001. The other neonatal pulmonary diseases that were studied, CLD and PPHN, were much less likely to be affected and were much more variable in their neurotrophin expression.Conclusion: NT expression is decreased in CDH lungs. The decreased expression of NT in CDH lung tissue may suggest they contribute to the abnormality in this condition.Keywords: nerve growth factor, NGF, brain-derived neurotrophic factor, BDNF, neurotrophin-3, NT-3, chronic lung disease, persistent pulmonary hypertension, lung

Early versus late surgical correction in congenital diaphragmatic hernia

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Alexandra Yunes

2017-11-01

Full Text Available Resumen INTRODUCCIÓN El momento de la reparación quirúrgica en pacientes con hernia diafragmática congénita ha sido un tema controvertido a lo largo de los años, y aún no existe un acuerdo sobre si es preferible una reparación inmediata o una cirugía tardía con estabilización preoperatoria. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cuatro revisiones sistemáticas que en conjunto incluyen 38 estudios primarios, de los cuales, dos son ensayos aleatorizados. Concluimos que no está claro si la reparación quirúrgica inmediata en hernia diafragmática congénita aumenta la mortalidad o disminuye los días de hospitalización en comparación a una reparación tardía porque la certeza de la evidencia es muy baja.

Prophylactic use of the Arabin cervical pessary in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO): preliminary experience.

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Dobrescu, Oana; Cannie, Mieke M; Cordier, Anne-Gael; Rodó, Carlota; Fabietti, Isabella; Benachi, Alexandra; Carreras, Elena; Persico, Nicola; Hurtado, Ivan; Gucciardo, Léonardo; Jani, Jacques C

2016-01-01

The aim of this study was to describe whether the prophylactic use of a cervical pessary decreases the rate of premature birth in congenital diaphragmatic hernia (CDH) fetuses treated with fetoscopic tracheal occlusion (FETO). The study concerns a consecutive series of cases with CDH and FETO and a group of CDH without FETO. In a subgroup of the FETO group, a prophylactic cervical pessary was inserted the day following the procedure. Gestational age (GA) at birth was the primary outcome. Fifty-nine fetuses with FETO and 47 expectantly managed were included. The last 15 FETO had a cervical pessary inserted. The median GA at delivery in the FETO group with pessary was 35.1 weeks and was not different from that in the FETO group without a pessary (34.3 weeks; p = 0.28) but was below that in the expectantly managed group (38.3 weeks; p cervical pessary does not prolong gestation of CDH fetuses treated with FETO. © 2015 John Wiley & Sons, Ltd. © 2015 John Wiley & Sons, Ltd.

Gastric volvulus due to diaphragmatic eventration and paraesophageal hernia

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DOĞAN, Nurettin Özgür; AKSEL, Gökhan; DEMİRCAN, Ahmet; KELEŞ, Ayfer; BİLDİK, Fikret

2014-01-01

Acute gastric volvulus occurs when the stomach or a part of it rotates more than 180 degrees. It is a potentially life-threatening entity and most cases of gastric volvulus occur in association with eventration of left hemidiaphragm or a hiatal hernia. Gastric volvulus is a rare condition and presents with nonspecific epigastric pain and vomiting, and therefore may be missed. Chest x-ray and CT can help the diagnosis. Emergent surgical approach is mandatory. Two elderly patients admitted t...

Amyand's hernia-a vermiform appendix presenting in an inguinal hernia: a case series

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Pavlidis Theodoros

2011-09-01

Full Text Available Abstract Introduction A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand's hernia. Here we present a case series of four men with Amyand's hernia. Case presentations We retrospectively studied 963 Caucasian patients with inguinal hernia who were admitted to our surgical department over a 12-year period. Four patients presented with Amyand's hernia (0.4%. A 32-year-old Caucasian man had an inflamed vermiform appendix in his hernial sac (acute appendicitis, presenting as an incarcerated right groin hernia, and underwent simultaneous appendectomy and Bassini suture hernia repair. Two patients, Caucasian men aged 36 and 43 years old, had normal appendices in their sacs, which clinically appeared as non-incarcerated right groin hernias. Both underwent a plug-mesh hernia repair without appendectomy. The fourth patient, a 25-year-old Caucasian man with a large but not inflamed appendix in his sac, had a plug-mesh hernia repair with appendectomy. Conclusion A hernia surgeon may encounter unexpected intraoperative findings, such as Amyand's hernia. It is important to be prepared and apply the appropriate treatment.

Gender-related differences of inguinal hernia and asymptomatic patent processus vaginalis in term and preterm infants.

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Burgmeier, Christine; Dreyhaupt, Jens; Schier, Felix

2015-03-01

The aim of this study was to analyze the gender-related differences of inguinal hernia (IH) and patent processus vaginalis (PPV) in term and preterm infants. Over a nine-year-period 411 infants underwent laparoscopic herniorrhaphy within the first six months of life. 246 term (191 male; 55 female) and 165 preterm (118 male; 47 female) infants were included in this retrospective study. Initial presentation of IH and intraoperative anatomical findings of PPV were reviewed. We found that term boys (58.6%) and girls (58.2%) predominantly presented with right-sided IH whereas preterm boys (36.4%) and girls (44.7%) mostly presented with bilateral IH. Female babies had a higher incidence of initial left-sided IH. Term and preterm girls with initial left-sided hernia were found to have highest incidence of PPV. Male term babies with initial left-sided IH were found to have the lowest incidence of PPV (25.0%). The highest incidence of PPV in male was found in preterm boys with either left- or right-sided IH. Incidence and laterality of IH and PPV differ between term and preterm girls and boys. In open hernia repair decision concerning contralateral groin exploration should consider term/preterm birth as well as gender. Copyright © 2015 Elsevier Inc. All rights reserved.

Incidental Hiatal Hernia Detected with Meckel's Scintigraphy

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Aksoy, Tamer [Afyon Kocatepe Univ. Medical Faculty, Afyon (Turkmenistan); Kiratli, Pinar Ozgen [Hacettepe Univ. Medical Faculty, Ankara (Turkmenistan)

2011-03-15

Congenital hiatal hernia (CHH) in children is a very rare condition that occurs in about 1 in every 2,000 to 5,000 live births, with a male to female ratio of 2:3. In 97% of cases the anomaly is unilateral with a left side preponderance. The hernia content can include the stomach, bowel loops, spleen or part of the liver. CHH may remain asymptomatic or induce only nonspecific gastro intestinal and/or thoracic symptoms. The symptomatology og these patients is usually non specific, in the form of repeated attacks of chest infection and/or recurrent vomiting, but can be associated with serious complications such as intrathoracic gastric volvulus with incarceration and strangulation. Because of the gastroesophageal reflux, linear ulcerations on the esophageal mucosa might occur and cause intermittent bleeding. Plan chest radiographs, AP and lateral, may raise a suspicion of the condition, while upper gastrointestinal contrast series are diagnostic. The treatment is surgery consisting of excision of the hernial sac after reducing the stomach and repair of the diaphragmatic defect by tightening the crura of the esophageal hiatus. If the defect is large and associated with displacement of the gastroesophageal junction (GEJ) into the thorax, adding an anti reflux procedure to the repair is appropriate. This can be achieved transabdominally either by laparotomy or laparoscopically. To the best of our knowledge, this is the second case diagnosed with Meckel's scintigraphy.

Health-related quality of life and its determinants in children with a congenital diaphragmatic hernia

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2013-01-01

Background The development of new therapeutics has led to progress in the early management of congenital diaphragmatic hernia (CDH) in pediatric intensive care units (PICU). Little is known about the impact on the quality of life (QoL) of children and their family. The aim of this study was to assess the impact of CDH treated according to the most recent concepts and methods outlined above on child survivors’ QoL and their parents’ QoL. Patients and methods This study incorporated a cross-sectional design performed in two PICU (Marseille, France). Families of CDH survivors born between 1999 and 2008 were eligible. The following data were recorded: socio-demographics, antenatal history and delivery, initial hospitalization history. Self-reported data were collected by mail, including current clinical problems of the children (13-symptom list), children’s QoL (Kidscreen-27 questionnaire), and parents’ QoL (Short-Form 36 questionnaire). Children’s QoL score was compared with controls and QoL of survivors of childhood leukemia. Parent’s QoL was compared with controls. Non-parametric statistics were employed. Results Forty-two families agreed to participate and questionnaires were completed by 32 of them. Twenty-one children had a current clinical problems related to CDH. All the QoL scores of CHD survivors were significantly lower compared with controls. The physical well-being dimension was significantly higher for CHD survivors compared with survivors of childhood leukemia. Gastro-esophageal reflux at discharge, antenatal diagnosis, length of stay in the PICU, and neuropsychological and respiratory issues significantly impacted QoL scores of children. The parents of CHD survivors had significantly poorer score in emotional role dimension compared with controls. Conclusion The impact of CDH on QoL seems to be important and must be understood by clinicians who treat these children and their parents. PMID:23786966

Endometriosis-related spontaneous diaphragmatic rupture.

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Triponez, Frédéric; Alifano, Marco; Bobbio, Antonio; Regnard, Jean-François

2010-10-01

Non-traumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known. We report the case of endometriosis-related spontaneous rupture of the right diaphragm with intrathoracic herniation of the liver, gallbladder and colon. We hypothesize that the invasiveness of endometriotic tissue caused diaphragm fragility, which finally lead to its complete rupture without traumatic event. The treatment consisted of a classical management of diaphragmatic rupture, with excision of the endometriotic nodule followed by medical ovarian suppression for six months.

Predictive capabilities of preoperative and postoperative pulmonary function tests in delayed repair of congenital diaphragmatic hernia.

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Tracy, T F; Bailey, P V; Sadiq, F; Noguchi, A; Silen, M L; Weber, T R

1994-02-01

To improve the survival of newborns with congenital diaphragmatic hernia (CHD), preoperative stabilization with conventional ventilatory therapy and extracorporeal membrane oxygenation (ECMO) have been used. Measurements that quantify pulmonary function may allow an accurate assessment of lethal pulmonary hypoplasia and predict outcome. Pulmonary function tests (PFTs) were obtained in 20 infants preoperatively and postoperatively; these included measurements of compliance, dynamic compliance, and tidal volume. Overall survival was 75%. Six surviving infants were initially managed with ventilator therapy alone, followed by repair (group 1). The remaining 14 patients, who were moribund at presentation or whose initial ventilator therapy failed, were placed on ECMO and received repair during bypass; nine survived (group 2), and five died (group 3). Compliance, dynamic compliance, and tidal volume obtained at initial presentation and immediately preoperatively were significantly higher for group 1 as compared with groups 2 and 3. Infants whose initial compliance was greater than 0.25 mL/cm H2O/kg and initial tidal volume was greater than 3.5 mL/kg did not require ECMO. Ultimate improvement in compliance was noted in 5 of 6 patients in group 1, 8 of 8 patients in group 2, and 5 of 5 in group 3. This improvement followed an initial decline in compliance in 9 of 14 survivors, from 15% to 76%. All six patients in group 1 had tidal volumes of more than 4 mL/kg, as did 7 of 9 patients in group 2. Only one patient among the ECMO nonsurvivors (group 3) had a postoperative tidal volume of this magnitude. These data suggest that initial PFTs may predict which infants will require ECMO.(ABSTRACT TRUNCATED AT 250 WORDS)

The Upturned Superior Mesenteric Artery Sign for First-Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele.

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Lakshmy, Ravi Selvaraj; Agnees, Joy; Rose, Nity

2017-03-01

The aim of this study was to follow the course of the superior mesenteric artery (SMA) in first-trimester fetuses to predict the location of the small bowel. Its abnormal course aids in early detection of congenital diaphragmatic hernia (CDH) and assessment of the contents of omphalocele. The SMA can be easily identified in a sagittal section of the fetus by using color Doppler sonography at the 11- to 14-week scan, and normally, it has a downward course caudally to supply the intestines. The course of the SMA points to the location of the bowel. We report a series of 7 cases detected in first trimester with an abnormal course of the SMA, 3 of which had CDH and 4 of which had omphalocele. In CDH, the intestines herniate into the thoracic cavity; hence, the SMA tends to have an upward course toward the thorax. In 4 cases of omphalocele, the SMA follows the exteriorized bowel into the base of the umbilical cord. Second-trimester sonography for detection of congenital malformations is a standardized protocol, but a careful anatomic survey at the 11- to 14-week scan is often rewarding. When there is a suspicion of an intrathoracic mass or a mediastinal shift, the upturned course of SMA serves as a valuable sign in confirmation of CDH. Chromosomal abnormalities are often reported in cases of omphalocele containing small bowel only, and the upward course of the SMA toward the base of the cord helps in its early prenatal diagnosis, which facilitates early genetic assessment in these fetuses. © 2017 by the American Institute of Ultrasound in Medicine.

BMP4 and LGL1 are Down Regulated in an Ovine Model of Congenital Diaphragmatic Hernia

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Heather eEmmerton-Coughlin

2014-11-01

Full Text Available Background/Purpose: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP 4 and other factors such as late gestation lung protein 1 (LGL1, are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model. Methods: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was created in 7 experimental animals. Lungs were harvested at 136 days (term=145d. Lung weight and mean terminal bronchiole density (MTBD were measured to determine the degree of pulmonary hypoplasia. Quantitative real time PCR was undertaken to analyze Wnt2, Wnt7b, BMP4 and LGL1 mRNA expression. Results: Total lung weight was decreased while MTBD was increased in the CDH group (p<0.05, confirming pulmonary hypoplasia. BMP4 and LGL1 mRNA was significantly reduced in CDH lungs (p<0.05. Wnt2 mRNA was decreased, although not significantly (p<0.06. Conclusions: For the first time, down regulation of BMP4 and Lgl1 are reported in an ovine CDH model. In contrast to other animal models, these changes are persistent to near term. These findings suggest that mechanical compression from herniated viscera may play a more important role in causing pulmonary hypoplasia in CDH, rather than a primary defect in lung organogenesis.

Crura sign: differentiation between traumatic rupture of the diaphragm and nontraumatic diaphragmatic elevation on CT

International Nuclear Information System (INIS)

Kim, Sung Jin; Han, Hae Ja; Kim, Wang Jung; Youk, Yong Soo; Han, Gi Seok; Cha, Sang Hoon; Park, Kil Sun; Kim, Dae Young

1997-01-01

To evaluate whether in patients with diffuse evaluation of a hemidiaphragm on chest radiographs, the apparence of the crura on CT might be helpful in differentiating between traumatic rupture of the diaphragm (TRD) and nontraumatic causes such as diaphragmatic palsy or diffuse diaphragmatic eventration. Among patients with diffuse elevations of a hemidiaphragm on chest radiograph, 27 who had patients undergone CT scans were retrospectively reviewed. Twelve patients had surgically proven TRD, and 15 had nontraumatic elevation of a hemidiaphragm such as diaphragmatic palsy or diffuse diaphragmatic eventration. Under the hypothesis that the affected crus is markedly thinner than the normal side in nontraumatic elevation but is normal in TRD ('crura sign', we optically assessed without measurement the thickness of both crura. In all patients with TRD, the thickness of the affected crus was similar to that of the contralateral side. In all patients with nontraumatic causes, however, the crus of the elevated hemidiaphragm was markedly thinner than that of the normal side. The 'crura sign' may be useful additional CT finding of traumatic rupture the diaphragm

Incarcerated Pediatric Hernias.

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Abdulhai, Sophia A; Glenn, Ian C; Ponsky, Todd A

2017-02-01

Indirect inguinal hernias are the most commonly incarcerated hernias in children, with a higher incidence in low birth weight and premature infants. Contralateral groin exploration to evaluate for a patent processus vaginalis or subclinical hernia is controversial, given that most never progress to clinical hernias. Most indirect inguinal hernias can be reduced nonoperatively. It is recommended to repair them in a timely fashion, even in premature infants. Laparoscopic repair of incarcerated inguinal hernia repair is considered a safe and effective alternative to conventional open herniorrhaphy. Other incarcerated pediatric hernias are extremely rare and may be managed effectively with laparoscopy. Copyright © 2016 Elsevier Inc. All rights reserved.

Concurrent Mesh Repair of a Morgagni and Umbilical Hernia during a Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Individual

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N.R Kosai

2016-10-01

Full Text Available Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

Dedifferentiated retroperitoneal liposarcoma presenting as right inguinal hernia: A case report

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Kim, Jung Myung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of); Choi, Moon Hyung [Dept. of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

2016-01-15

Retroperitoneal liposarcomas usually present as painless, slow-growing abdominal masses. When masses grow large enough to compress surrounding structures, symptoms may occur. Retroperitoneal liposarcoma clinically manifesting as inguinal hernia is a very rare entity; only 11 cases have been reported. Herein, we present radiographic features of a 37-year-old male with a painless palpable mass in the right groin that was identified as dedifferentiated retroperitoneal liposarcoma herniated through the right inguinal canal.

Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia

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Chang, Patricia T.; Taylor, George A. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

2015-07-15

Neonates with congenital diaphragmatic hernia (CDH) often require placement of lines and tubes for supportive therapy. The resulting altered anatomy can result in diagnostic errors when interpreting the location of support lines and tubes such as UVCs (umbilical venous catheters). The purpose of this study was to evaluate the effect of CDH on UVC position and to evaluate the accuracy at which radiologists describe the position on chest radiographs. During a 5-year period, 406 chest radiographs performed within 7 days of birth in infants with congenital diaphragmatic hernia were identified and reviewed for the following data: presence of UVC, location of catheter tip (cavoatrial junction, intracardiac, intrahepatic or umbilical vein), and location of CDH (right or left). The radiologic report of the UVC tip location for each case was then reviewed individually to determine the adequacy of interpretation. Inadequate reports were classified as incorrect (the wrong location of the catheter tip was reported), no mention (the location of the catheter tip was in a suboptimal location but not mentioned), and not specified (the precise location of the catheter tip was not clearly stated in the report when the tip was in a suboptimal location). A total of 60 infants were identified as having CDH (56 on the left, 4 on the right). The most common location for an incorrectly placed UVC was the contralateral chest, accounting for 26.7% (16/60) of the infants, followed by an abdominal intrahepatic location (16.7%) and the umbilical vein (8.3%). Thirty percent (120/406) of the chest radiograph reports were found to be inadequate regarding the interpretation of the location of the catheter tip. The majority of the inadequate reports (48/406, 11.8%) did not specify when the catheter tip was in a suboptimal location. In 37 reports (9.1%), the location of the catheter tip was reported incorrectly, and no mention of the catheter location was made in 35 reports (8.6%). The location of

Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia

International Nuclear Information System (INIS)

Chang, Patricia T.; Taylor, George A.

2015-01-01

Neonates with congenital diaphragmatic hernia (CDH) often require placement of lines and tubes for supportive therapy. The resulting altered anatomy can result in diagnostic errors when interpreting the location of support lines and tubes such as UVCs (umbilical venous catheters). The purpose of this study was to evaluate the effect of CDH on UVC position and to evaluate the accuracy at which radiologists describe the position on chest radiographs. During a 5-year period, 406 chest radiographs performed within 7 days of birth in infants with congenital diaphragmatic hernia were identified and reviewed for the following data: presence of UVC, location of catheter tip (cavoatrial junction, intracardiac, intrahepatic or umbilical vein), and location of CDH (right or left). The radiologic report of the UVC tip location for each case was then reviewed individually to determine the adequacy of interpretation. Inadequate reports were classified as incorrect (the wrong location of the catheter tip was reported), no mention (the location of the catheter tip was in a suboptimal location but not mentioned), and not specified (the precise location of the catheter tip was not clearly stated in the report when the tip was in a suboptimal location). A total of 60 infants were identified as having CDH (56 on the left, 4 on the right). The most common location for an incorrectly placed UVC was the contralateral chest, accounting for 26.7% (16/60) of the infants, followed by an abdominal intrahepatic location (16.7%) and the umbilical vein (8.3%). Thirty percent (120/406) of the chest radiograph reports were found to be inadequate regarding the interpretation of the location of the catheter tip. The majority of the inadequate reports (48/406, 11.8%) did not specify when the catheter tip was in a suboptimal location. In 37 reports (9.1%), the location of the catheter tip was reported incorrectly, and no mention of the catheter location was made in 35 reports (8.6%). The location of

Littre hernia in childhood: A case report with a brief review of the literature

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Arzu Pampal

2011-01-01

Full Text Available A 3-year-old boy with a right-sided and painful inguinal swelling for the last 2 h was admitted to the emergency department. As there were no apparent peritoneal irritation findings, right-sided incarcerated inguinal hernia was reduced and the patient was scheduled for an elective herniorrhaphy. Perioperatively even though the sac seemed empty, it was opened in order to inspect its content. The adherence of Meckel′s diverticulum (MD to the base of hernial sac was realized and Littre hernia (LH was diagnosed. The hernia was highly ligated after the wedge resection of the diverticulum and anastomosis. The patient was fed on the second postoperative day and discharged on the third postoperative day. Despite numerous presentations of LH in the adult age group in the literature, there are limited data about the disease in the childhood period. Even though the scarcity of the data, there are some so-called rules for LH in childhood like protruding more common through umbilical hernias, containing heterotopic tissues more frequent than adult age and incarcerating/strangulating more often. The aim of this study is to review the reported LH cases, present a new case and discuss the features of LH in childhood period.

Prenatal tracheal ligation or intra-amniotic administration of surfactant or dexamethasone prevents some structural changes in the pulmonary arteries of surgically created diaphragmatic hernia in rabbits Ligadura de traquéia no período pré-natal ou administração intra-amniótica de surfactante ou dexametasona evitam algumas alterações estruturais nas artérias pulmonares de fetos de coelho com hérnia diafragmática congênita produzida com cirurgia

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Consuelo J. Rodrigues

2002-02-01

Full Text Available PURPOSE: Characterization of the structural changes occurring in the pulmonary arteries resulting from surgically produced congenital diaphragmatic hernia in rabbits, with particular emphasis on the preventive effects of prenatal tracheal ligation or administration of intra-amniotic dexamethasone or surfactant. METHODS: Twenty rabbit fetuses underwent surgical creation of a left-sided congenital diaphragmatic hernia on the 24th or 25th gestational day. They were divided according to the following procedures: congenital diaphragmatic hernia (n = 5, congenital diaphragmatic hernia plus tracheal ligation (n = 5, congenital diaphragmatic hernia plus intra-amniotic administration of dexamethasone 0.4 mg (n = 5 or surfactant (Curosurf 40 mg, n = 5. On gestational day 30, all the fetuses were delivered by caesarean section and killed. A control group consisted of five nonoperated fetuses. Histomorphometric analysis of medial thickness, cell nuclei density, and elastic fiber density of pulmonary arterial walls was performed. RESULTS: Arteries with an external diameter > 100 mum have a decreased medial thickness, lower cell nuclei density, and greater elastic fiber density when compared with arteries with external diameter 100 mum. Prenatal treatments with tracheal ligation or intra-amniotic administration of dexamethasone or surfactant prevented these changes. In arteries with external diameter OBJETIVO: Caracterização das alterações estruturais que ocorrem nas artérias pulmonares de fetos de coelho com hérnia diafragmática congênita produzida com cirurgia, com destaque especial aos efeitos preventivos da ligadura de traquéia ou administração intra-amniótica de dexametasona ou surfactante. MÉTODOS: Vinte fetos de coelho foram submetidos a cirurgia para produção de hérnia diafragmática no 24º ou 25º dia de gestação. Os animais foram divididos de acordo com os procedimentos: hérnia diafragmática congênita (n = 5, hérnia diafragm

An unusual presentation of congenital bronchoesophageal fistula ...

African Journals Online (AJOL)

Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed. Key Words: Bronchoesophageal fistula, Hiatus hernia, ...

Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation.

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Haricharan, Ramanath N; Barnhart, Douglas C; Cheng, Hong; Delzell, Elizabeth

2009-01-01

The purpose of this study was to identify mortality risk factors in children with congenital diaphragmatic hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO) and generate a prediction score for those at a very high risk for mortality. Data on first ECMO runs of all neonates with CDH, between January 1997 and June 2007, were obtained from the Extracorporeal Life Support Organization registry (N = 2678). The data were split into "training data (TD)" (n = 2006) and "validation data" (n = 672). The primary outcome analyzed was in-hospital mortality. Modified Poisson regression was used for analyses. Overall in-hospital mortality among 2678 neonates (males, 57%; median age at ECMO, 1 day) was 52%. The univariate and multivariable analyses were performed using TD. An empirically weighted mortality prediction score was generated with possible scores ranging from 0 to 35 points. Of 69 who scored 14 or higher in the TD, 62 died (positive predictive value [PPV], 90%), of 37 with 15 or higher, 35 died (PPV, 95%), of 23 with 16 or higher, 22 died (PPV, 96%). A cut-off point of 15 was chosen and was tested using the separate validation dataset. In validation data, the cut-off point 15 had a PPV of 96% (23 died of 24). Scoring 15 or higher on the prediction score identifies neonates with CDH at a very high risk for mortality among those managed with ECMO and could be used in surgical decision making and counseling.

Complicated childhood inguinal hernias in UITH, Ilorin

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Kayode T Bamigbola

2012-01-01

Full Text Available Background: Complicated inguinal hernias pose a threat to the life of the child as well as increase the morbidity associated with management of an otherwise straightforward condition. The aim of this study was to determine the presentation, treatment and management outcome of complicated inguinal hernias in children. Materials and Methods: A retrospective study of all children 15 years and less managed for complicated inguinal hernia between 2002 and 2010. Data obtained included demographic characteristics, presentation, operative findings and outcome. Results: Complicated hernia rate was 13.9%.There were 41 children, 38 boys (92.7% and 3 girls. Ages ranged between 4 days and 15 years (Median = 90days. Most were infants (48.8%, n = 20 and neonates accounted for 19.5% (n = 8. Median duration of symptoms prior to presentation was 18 h (range = 2-96 h. Seven patients had been scheduled for elective surgery. Hernia was right sided in 68.3% (n = 28. Symptoms included vomiting (68.3%, abdominal distension (34.1% and constipation (4.9%; one patient presented with seizures. In 19 (46.3% patients hernia was reducible while 22(53.7% had emergency surgery. Associated anomalies included undescended testis (12.2%, umbilical hernia (14.6%. Intestinal resection rate was 7.3% and testicular gangrene occurred in 14.6%. Mean duration of surgery was 60.3 ± 26.7 min. Wound infection occurred in six patients (14.6%. Overall complication rate was 24.4%, 30% in infants. The mortality rate was 2.4% (n = 1. Conclusions: Morbidity associated with complicated inguinal hernia is high in neonates and infants. Delayed presentation is common in our setting. Educating the parents as well as primary care physicians on the need for early presentation is necessary.

Surgical repair of incarcerated inguinal hernia in children: laparoscopic or open?

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Nah, S A; Giacomello, L; Eaton, S; de Coppi, P; Curry, J I; Drake, D P; Kiely, E M; Pierro, A

2011-01-01

The management of Incarcerated Inguinal Hernia (IIH) in children is challenging and may be associated with complications. We aimed to compare the outcomes of laparoscopic vs. open repair of IIH. With institutional ethical approval (09SG13), we reviewed the notes of 63 consecutive children who were admitted to a single hospital with the diagnosis of IIH between 2000 and 2008. Data are reported as median (range). Groups were compared by chi-squared or t-tests as appropriate. · Open repair (n=35): There were 21 children with right and 14 with left IIH. 2 patients also had contralateral reducible inguinal hernia. Small bowel resection was required in 2 children. · Laparoscopic repair (n=28): All children had unilateral IIH (19 right sided, 9 left sided). 15 children (54%) with no clinical evidence of contralateral hernia, had contralateral patent processus vaginalis at laparoscopy, which was also repaired. The groups were similar with regard to gender, age at surgery, history of prematurity, interval between admission and surgery, and proportion of patients with successful preoperative manual reduction. However, the duration of operation was longer in the laparoscopy group (p=0.01). Time to full feeds and length of hospital stay were similar in both groups. Postoperative follow-up was 3.5 months (1-36), which was similar in both groups. 5 patients in the group undergoing open repair had serious complications: 1 vas transaction, 1 acquired undescended testis, 2 testicular atrophy and 1 recurrence. The laparoscopic group had a single recurrence. Open repair of incarcerated inguinal hernia is associated with serious complications. The laparoscopic technique appears safe, avoids the difficult dissection of an oedematous sac in the groin, allows inspection of the reduced hernia content and permits the repair of a contralateral patent processus vaginalis if present. © Georg Thieme Verlag KG Stuttgart · New York.

An Elderly Male with Amyand’s Hernia

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Saema Said

2017-09-01

Full Text Available History of present illness: A 67-year-old male, with a history of diabetes, coronary artery disease, and chronic kidney disease, presented with two weeks of a new right inguinal bulge and right lower quadrant abdominal pain extending to the groin. He denied nausea, vomiting, fever, and changes in bowel movement. His initial vital signs were: temperature 37.4°C, blood pressure 142/100, heart rate 62, and respiratory rate 18. Physical examination revealed mild right lower quadrant abdominal tenderness, right inguinal and testicular tenderness and swelling, and a non-reducible bulging inguinal mass with no overlying skin changes. Lab results showed a leukocytosis of 13.6. Significant findings: Ultrasound of the right scrotum shows a right inguinal hernia with an air-containing loop of bowel (white arrow and a non-compressible appendix (yellow arrow. Coronal and axial views of abdomen-pelvis CT show a right inguinal hernia containing a loop of small bowel (white arrow and appendix (yellow arrow. Discussion: In the case presented above, ultrasound and abdomen and pelvis computed tomography (CT showed an Amyand’s hernia. The patient was taken emergently to surgery, which revealed an incarcerated right inguinal hernia with perforated appendicitis in the hernia sac. The patient underwent an appendectomy and hernia repair, and had no post-surgical complications. Amyand’s hernia is a form of inguinal hernia characterized by the presence of the appendix in the hernia sac. The hernia may be reducible, incarcerated, or strangulated; and the appendix may be normal, inflamed, or perforated.1 The patient presented above had an incarcerated hernia with no overlying skin changes suggestive of strangulation. Amyand’s hernia accounts for 0.4-1% of all inguinal hernias and 0.1% of all cases of appendicitis.2 It is thought to be due to patency of the processus vaginalis, and as such occurs more frequently in young children.1,2,3 Clinical diagnosis of Amyand�

Hérnias diafragmáticas traumáticas: Revisão casuística Traumatic diaphragmatic hernias: Retrospective analysis

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JPA Sousa

2006-05-01

dificuldade de diagnóstico pré-operatória continua a requerer elevado grau de suspeição, exigindo-se sempre a colocação desta hipótese de diagnóstico no contexto de traumatismos toraco-abdominais fechados.Aims: This study classifies cases of traumatic diaphragmatic hernias (TDH in patients admitted to the Intensive Care Unit (ICU of the Coimbra University Hospitals (HUC from 1990 to 2004. Methods: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. Results: Twenty-eight male and six female patients with an average age of 40.5 years ± 20.5, average SAPS score 38.8. Average lenght of stay was 19.1± 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1% then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. Conclusions: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of

Ovarian Spigelian hernia: A radiological diagnosis

International Nuclear Information System (INIS)

Hill, Ciaran Scott; Chahil, Balvinder; Marlow, Benjamin

2012-01-01

We describe that case of a 54 year old lady with achondroplasia who presented with ongoing left sided abdominal pain. Ultrasound and abdominal computerized tomography images demonstrated an enlarged left ovary and Fallopian tube trapped between the rectus abdominus and the lateral semilunar line under cover of the external oblique aponeurosis. A left sided salpingoophrectomy with mesh herniorrhaphy was performed and histological analysis confirmed the hernia contents were a hydrosalpinx and normal ovary. This case report presents the unusual radiographic images and intraoperative photographs of an ovarian Speglian hernia.

Parastomal hernia and physical activity. Are patients getting the right advice?

Science.gov (United States)

Russell, Sarah

2017-09-28

This article draws on a large nationwide survey (2631 respondents) that investigated the physical health and wellbeing of people living with stomas in the UK. It specifically considers the findings relating to parastomal hernia (where additional loops of bowel protrude through the abdominal wall around the stoma, creating a bulge). In this survey, 26% of respondents reported that they had a medically diagnosed parastomal hernia, which is below average when compared with other estimates. The impact of parastomal hernia on physical activity levels was the most significant finding: 32% of those with a medically diagnosed hernia reported being 'much less active' than they were prior to their surgery (compared with 19% without a hernia). This creates a more serious problem for general health-significantly increasing their risk of co-morbidities such as cancer, stroke, diabetes and other chronic conditions related to physical inactivity. Clinical guidelines clearly state that patients should be informed of exercises to strengthen core muscles, as part of hernia prevention, but 88% of patients did not engage in any sort of abdominal or core exercises. When asked, 69% of patients did not realise it was important and 82% of patients could not recall being given advice to do abdominal exercises as part of their recovery. There is a significant gap in the patient care pathway regarding advice on physical activity, core/abdominal exercises and hernia prevention and management after stoma surgery. This is an area that urgently needs more research and education for patients and all health professionals.

Prenatal diagnosis of two fetuses with deletions of 8p23.1, critical region for congenital diaphragmatic hernia and heart defects.

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Keitges, Elisabeth A; Pasion, Romela; Burnside, Rachel D; Mason, Carla; Gonzalez-Ruiz, Antonio; Dunn, Teresa; Masiello, Meredith; Gebbia, Joseph A; Fernandez, Carlos O; Risheg, Hiba

2013-07-01

Microdeletions of 8p23.1 are mediated by low copy repeats and can cause congenital diaphragmatic hernia (CDH) and cardiac defects. Within this region, point mutations of the GATA4 gene have been shown to cause cardiac defects. However, the cause of CDH in these deletions has been difficult to determine due to the paucity of mutations that result in CDH, the lack of smaller deletions to refine the region and the reduced penetrance of CDH in these large deletions. Mice deficient for one copy of the Gata4 gene have been described with CDH and heart defects suggesting mutations in Gata4 can cause the phenotype in mice. We report on the SNP microarray analysis on two fetuses with deletions of 8p23.1. The first had CDH and a ventricular septal defect (VSD) on ultrasonography and a family history of a maternal VSD. Microarray analysis detected a 127-kb deletion which included the GATA4 and NEIL2 genes which was inherited from the mother. The second fetus had an incomplete atrioventricular canal defect on ultrasonography. Microarray analysis showed a 315-kb deletion that included seven genes, GATA4, NEIL2, FDFT1, CTSB, DEFB136, DEFB135, and DEFB134. These results suggest that haploinsufficiency of the two genes in common within 8p23.1; GATA4 and NEIL2 can cause CDH and cardiac defects in humans. Copyright © 2013 Wiley Periodicals, Inc.

Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

International Nuclear Information System (INIS)

Kaya, Seyda Ors; Karabulut, Nevzat; Yuncu, Gokhan; Sevinc, Serpil; Kiroglu, Yilmaz

2006-01-01

The objective of our study was to describe the 'sinus cut-off' sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the 'sinus cut-off sign' was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The 'sinus cut-off sign' is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion

Lumbar hernia in South Korea: different from that in foreign literature?

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Park, S H; Chung, H S; Song, S H

2015-10-01

This study aimed to analyze the clinical features of lumbar hernia reported in South Korea and compare these features with those reported in foreign literature. From January 1968 through December 2013, 13 cases reported in South Korea were included in the study. The variables compared were age, sex, main symptoms at hospital visit, etiology, location, herniated contents, lateralization, defect size, diagnostic methods, surgical methods, surgical opinions, and recurrence. In the South Korean cases, women outnumbered men (3.3:1) and no significant differences were found in the herniated side (left:right, 1.1:1). In contrast, in the foreign cases, men outnumbered women (3:1) and left-sided hernia was dominant (2:1). Moreover, in most of the foreign cases, patients were aged 50-70 years, whereas in the South Korean cases, none of the patients were in their 50 s. However, no substantial differences were found in etiology, anatomical locations, symptoms, and herniated contents. This research revealed that few clinical features of lumbar hernias in South Korea differ from those reported in foreign literature. Thirteen cases were analyzed in the present study, and results obtained from such a small sample size cannot be generalized with certainty. Therefore, more cases should be collected for a definitive analysis. Despite this limitation, this study is important because it is the first attempt to collect and analyze the clinical features of lumbar hernia in South Korea. This study will serve as a basis for future studies investigating the clinical features of lumbar hernia cases in South Korea.

Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease.

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Debus, Angelika; Hagelstein, Claudia; Kilian, A Kristina; Weiss, Christel; Schönberg, Stefan O; Schaible, Thomas; Neff, K Wolfgang; Büsing, Karen A

2013-03-01

To assess whether chronic lung disease (CLD) in surviving infants with congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia on the basis of the results of antenatal observed-to-expected fetal lung volume (FLV) ratio measurement at magnetic resonance (MR) imaging. The study received approval from the institutional review board, with waiver of informed consent for this retrospective review from patients who had previously given informed consent for prospective studies. The ratio of observed to expected FLV at MR imaging was calculated in 172 fetuses with CDH. At postpartum day 28, the need for supplemental oxygen implicated the diagnosis of CLD. At day 56, patients with CLD were assigned to one of three groups-those with mild, moderate, or severe CLD-according to their demand for oxygen. Logistic regression analysis was used to assess the prognostic value of the individual observed-to-expected FLV ratio for association with postnatal development of CLD. Children with CLD were found to have significantly smaller observed-to-expected FLV ratios at MR imaging than infants without CLD (P CLD revealed significant differences in observed-to-expected FLV ratio between patients with mild CLD and those with moderate (P = .012) or severe (P = .007) CLD. For an observed-to-expected FLV ratio of 5%, 99% of patients with CDH developed CLD, compared with less than 5% of fetuses with an observed-to-expected FLV ratio of 50%. Perinatally, development and grade of CLD were further influenced by the need for extracorporeal membrane oxygenation (ECMO) (P CLD in surviving infants with CDH is associated with the prenatally determined observed-to-expected FLV ratio. Early neonatal therapeutic decisions can additionally be based on this ratio. Perinatally, ECMO requirement and gestational age at delivery are useful in further improving the estimated probability of CLD.

Outcome of laproscopic totally extraperitoneal hernioplasty for inguinal hernia

International Nuclear Information System (INIS)

Hanif, H.; Memon, S.H.

2015-01-01

Background: Hernioplasty for Inguinal hernia is one of the commonest operations performed in general surgical wards. More recently, interest has waxed and waned regarding the minimally invasive approach to hernioplasty. This study was carried out to assess the management outcome of minimally invasive hernioplasty (Totally extra-peritoneal approach) as the treatment of choice for uncomplicated (incomplete and reducible) inguinal hernia. Method: In this quasi experimental study patients aged between 14-83 years who were otherwise fit and willing for total extra-peritoneal laparoscopic repair were recruited prospectively over a 10 month period. Thirty-seven such patients were operated and followed up in the hernia clinics. Six cases were later excluded for lack of proper follow-up. Results: The typical patient was middle-aged male with right-sided inguinal hernia. Mean operating time was 53.3 minutes. No conversion was undertaken; however, there was one case of small bowel injury that went unrecognized on-table but necessitated subsequent laparotomy. Overall morbidity was 13.5 percentage. Mean length of hospitalization was 2.89 days. Mean duration to normal routine life was 9.25 days. Overall, 70.9 percentage of patients expressed satisfaction with the surgery. Conclusion: Totally extra-peritoneal mesh repair is a new and safe technique for hernioplasty with acceptable rates of morbidity and it is procedure of choice for recurrent and bilateral inguinal hernias and also used as alternate to open hernioplasty for uncomplicated (incomplete and reducible) inguinal hernia. (author)

Iloprost Instillation in Two Neonates with Pulmonary Hypertension

International Nuclear Information System (INIS)

Aktas, S.; Aksu, M.; Hirfanoglu, I. M.; Atalay, Y.; Turkyilmaz, C.; Unal, S.

2017-01-01

Pulmonary hypertension may coexist with certain diseases in neonates. Iloprost inhalation is one of the treatments which cause selective pulmonary vasodilatation. Inhalation is not an easy way of drug administration in mechanically ventilated infants; as some exhibit desaturations during inhalation. Moreover, inhalation of drug requires cessation of mechanical ventilation, if patient is on high frequency oscillatory ventilation. We presented two patients with pulmonary hypertension; term baby with congenital diaphragmatic hernia and preterm baby with respiratory distress syndrome; who had iloprost instillation during mechanical ventilation treatment. Iloprost instillation was well tolerated with no side effects in the term patient with diaphragmatic hernia; whereas severe blood pressure fluctuations were observed in the preterm infant. This report may courage administration of iloprost in term neonates with resistant pulmonary hypertension. (author)

Video-assisted thoracoscopy for diaphragmatic plication: experimental study in a canine model.

Science.gov (United States)

Gonzalez-Zamora, Jose F; Perez-Guille, Beatriz; Soriano-Rosales, Rosa E; Jimenez-Bravo-Luna, Miguel A; Gutierrez-Castrellon, Pedro; Ridaura-Sanz, Cecilia; Alvarez, Fernando Villegas

2005-12-01

Plication of a nonfunctional hemidiaphragm usually restores altered ventilatory mechanics. This study compared two techniques in performing diaphragmatic plication: video-assisted thoracoscopy (group A) and thoracotomy (group B). Twenty dogs with induced paralysis of the right hemidiaphragm were randomly assigned to one of the two groups. Evaluations were performed before and after plication of the respiratory frequency (f) and lung area (LA) of the affected side. Operative time, time to resumption of walking, ingestion of fluids and solid food, pain intensity, and postoperative complications were measured. Group A had less pain after the surgery (P fluid ingestion (P < 0.05), and earlier resumption of walking (P < 0.019). Four weeks after the procedure, LA was similar in both groups, while a significant decrease in f was recorded in group A (P < 0.02). The remaining evaluated variables showed no differences. Both approaches were effective. Pain recorded in the postoperative period was less and recovery was faster in group A. Complications and surgical times were similar. The video-assisted thoracoscopy is a safe and efficient option for performing diaphragmatic plication in dogs.

Ascending aortic aneurysm and diaphragmatic hernia in a case of Marfan syndrome.

Science.gov (United States)

Kothari, Jignesh; Hinduja, Manish; Baria, Kinnaresh; Pandya, Himani

2017-06-01

Marfan syndrome commonly affects the skeletal, ocular, and cardiovascular systems. Involvement of the gastrointestinal system is known but uncommon. Intervention depends upon the system involved and the severity of symptoms. Special awareness is required for the diagnosis and management of gastrointestinal involvement in these patients. We report a rare case of simultaneous surgical repair of an ascending aortic aneurysm and a type IV hiatal hernia in a 35-year-old man with Marfan syndrome.

Extragenital malignant mixed Mullerian tumor in the incisional hernia - primary carcinosarcoma in the abdominal wall: Case report

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Žuvela Marinko

2015-01-01

Full Text Available Introduction. This report presents a primary Mullerian carcinosarcoma localized in the incisional hernia i.e. anterior abdominal wall. There is no data in the literature about this localization of extragenital Mullerian carcinosarcoma. Case Outline. The patient had previous medical history of right-sided ovarian cystadenocarcinoma managed by hysterectomy, bilateral ovariectomy and chemotherapy. An incisional hernia occurred 1 year after the operation and Mullerian carcinosarcoma at the right border of the incisional hernia 16 years later. There was no tumor spreading into the abdominal cavity and pelvis. Full thickness of the abdominal wall resection and coexisting incisional hernia resulted in a large 25x20 cm abdominal wall defect managed by the modified components separation technique and implanting meshes. Conclusion. Major abdominal wall resection and abdominal wall reconstruction using the modified components separation technique reinforced with meshes could be one of possible solutions in the surgical treatment of primary malignant mixed Mullerian tumor localized in the abdominal wall. [Projekat Ministarstva nauke Republike Srbije, br. 41030

Gross hematuria as the presentation of an inguinoscrotal hernia: a case report

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Ansari Kayvan

2011-12-01

Full Text Available Abstract Introduction Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations. Case presentation A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms. Conclusion Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.

Left is right and right is wrong: fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy

International Nuclear Information System (INIS)

Joshi, Prathamesh; Lele, Vikram

2013-01-01

A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm. (author)

Left is right and right is wrong: Fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy.

Science.gov (United States)

Joshi, Prathamesh; Lele, Vikram

2013-01-01

A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm.

Body composition variation following diaphragmatic breathing ...

African Journals Online (AJOL)

Body composition variation following diaphragmatic breathing. ... effect of commonly prescribed diaphragmatic breathing training on the body composition ... a non-exercising control (NE) group (n = 22) or diaphragmatic breathing (DB) group.

Severe, recurrent hiatal hernia in schwartz syndrome

International Nuclear Information System (INIS)

Badshah, S.; Ghafoor, T.; Muhammad, S.

2003-01-01

An 18 months old boy presented with marked failure to thrive, abnormal facial grimacing and troublesome vomiting. The patient was diagnosed as having schwartz syndrome with hiatal hernia. Medical and surgical treatment was carried out and with supportive care the patient gained weight and his symptoms subsided. In 8 months, however, the patient developed hernia on the other side necessitating repeat surgery. The case is being reported to highlight the accompaniment of hiatal hernia not previously reported as part of the syndrome and to report the experience of using muscle relaxants in the condition. (author)

Mesh hernia repair and male infertility: a retrospective register study.

Science.gov (United States)

Hallén, Magnus; Westerdahl, Johan; Nordin, Pär; Gunnarsson, Ulf; Sandblom, Gabriel

2012-01-01

Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility. Copyright © 2012 Mosby, Inc. All rights reserved.

Minimally invasive repair of Morgagni hernia – A multicenter case series

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R. Lamas-Pinheiro

2016-09-01

Full Text Available Children may benefit from minimally invasive surgery (MIS in the correction of Morgagni hernia (MH. The present study aims to evaluate the outcome of MIS through a multicenter study.National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed.Thirteen patients with MH (6 males were operated using similar MIS technique (percutaneous stitches at a mean age of 22.2 ± 18.3 months. Six patients had chromosomopathies (46%, five with Down syndrome (39%. Respiratory complaints were the most common presentation (54%. Surgery lasted 95 ± 23 min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36% were admitted to intensive care unit (all with Down syndrome; all patients started enteral feeds within the first 24 h. With a mean follow-up of 56 ± 16.6 months, there were two recurrences (18% at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome.The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate. Keywords: Laparoscopy, Minimally invasive surgery, Percutaneous, Morgagni hernia, Diaphragmatic hernia

Paraduodenal hernia. A case report

International Nuclear Information System (INIS)

Irion, K.L.

1989-01-01

The authors present a case of right paraduodenal hernia and a brief review of the embriology and anatomy of the paraduodenal fossae as well as of the clinical signs, symptoms and radiologic aspects of paraduodenal hernias. (author) [pt

Pregnancy, parturition, parity and position in the family. Any influence on the development of paediatric inguinal hernia/hydrocele?

Science.gov (United States)

Irabor, D O; Ogundoyin O O; Ogunlana, D I

2014-01-01

To see if pre-partum factors have a relationship to the development of inguinal hernia in children. A prospective study on children with hernia. On first contact, the affected child was examined and data like the age, sex, weight, blood group, the diagnosis, side of the lesion and other co-morbid conditions was recorded. The mother filled a questionnaire about her age, parity, illness during pregnancy, her mode of delivery and the patient's position in the family. There were 104 patients from 103 mothers, their ages ranged from 13 days to 14 years with the highest incidence in the 1-4 age group. The sex ratio was overwhelmingly male (M:F ratio was 38:1). Right sided hernias were predominant. Only 7% had a family history. The peak age group of the mothers was 26-32 years and about 33% of the mothers had some illness during pregnancy. The birth positions of the patients showed that majority of them were either 1st or 2nd born children. Women of ages 26-32 likelyto have children with inguinal hernia. Malaria during pregnancy is unlikely to have a role to play. 1st and 2nd born male children have a higher chance of having inguinal hernia.

Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

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Ali Eraslan

2017-11-01

Conclusion: The study revealed that soccer players with osteitis pubis may have concomitant inguinal hernia, and that osteitis pubis may develop in soccer players who have undergone hernia repair. In addition, more severe osteitis pubis findings on the same side with hernia indicate that the two pathologies occur with common mechanisms. It should not be forgotten that inguinal hernia be considered in the differential diagnosis of osteitis pubis, which it may accompany. Conservative methods are mostly used in the treatment of osteitis pubis, whereas the treatment of inguinal hernia is surgery. If only one entity is diagnosed when both are present, the success of treatment will decrease.

The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review.

Science.gov (United States)

Toh, J W T; Lim, R; Keshava, A; Rickard, M J F X

2016-12-01

To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered. Colorectal Disease © 2016 The Association of Coloproctology

EVALUATION OF THORACOSCOPY IN THE DIAGNOSIS OF DIAPHRAGMATIC INJURIES IN PENETRATING THORACOABDOMINAL TRAUMA WITHOUT LUNG DEFLATION AT DR GEORGE MUKHARI ACADEMIC HOSPITAL.

Science.gov (United States)

Nsakala, L

2017-06-01

With a mortality estimated at 25% when missed, diaphragmatic injuries due to penetrating thoracoabdominal trauma present a diagnostic challenge for both the radiologist and the surgeon. In the current literature, chest x-ray has a sensitivity of 27-60% for left-sided injuries and only 17% for right-sided injuries while, CT scan has a sensitivity of 14-61% and a specificity of 76-99%. Thoracoscopy using a single lung ventilation is one of the modalities of choice for the diagnosis of these injuries with a specificity of 100% and a sensitivity of 87.5%. This was a prospective study; all stable trauma patients with penetrating thoracoabdominal injury aged 18 years and above admitted to the trauma unit at Dr George Mukhari Academic Hospital during the period of the study were included. All patients with penetrating thoracoabdominal trauma who were unstable, or necessitating prompt management and all paediatric patients were excluded from the study. In theatre, under general anaesthesia, we first performed thoracoscopy without single lung ventilation followed by laparoscopy as control on each patient. Data was collected using a standard proforma by the attending surgeon and was analysed by a statistician using IBM SPSS 22 software. A total of 32 patients met the inclusion criteria of which 4 were female (12.5%) and 28 male (87.5%) with the median age of 29 years. Of the 32 patients, 27 had thoracoabdominal stab wounds (84.3%) and 5 had gunshot wounds (15.6%). Fourteen patients (43.75%) had left sided injury and 18 patients (56.25%) had injury to the right side. The incidence of diaphragmatic injury was 37.5% (n = 12). No injuries were missed on thoracoscopy; there was no mortality or morbidity. Thoracoscopy without single lung ventilation is safe and comparable to thoracoscopy with single lung ventilation as a diagnostic tool for diaphragmatic injuries in stable patients with penetrating thoracoabdominal trauma.

The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial.

Science.gov (United States)

van den Hout, Lieke; Tibboel, Dick; Vijfhuize, Sanne; te Beest, Harma; Hop, Wim; Reiss, Irwin

2011-11-02

Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO) to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. This trial is designed as a multicentre trial in which 400 infants (200 in each arm) will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. Netherlands Trial Register (NTR): NTR1310.

An Unusual Trocar Site Hernia after Prostatectomy

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Ryan K. Schmocker

2016-01-01

Full Text Available Trocar site hernias are rare complications after laparoscopic surgery but most commonly occur at larger trocar sites placed at the umbilicus. With increased utilization of the laparoscopic approach the incidence of trocar site hernia is increasing. We report a case of a trocar site hernia following an otherwise uncomplicated robotic prostatectomy at a 12 mm right lower quadrant port. The vermiform appendix was incarcerated within the trocar site hernia. Subsequent appendectomy and primary repair of the hernia were performed without complication.

Pre-operative pain and sensory function in groin hernia

DEFF Research Database (Denmark)

Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

2009-01-01

BACKGROUND: Although persistent postherniotomy occurs in 5-10% of patients, pathogenic mechanisms remain debatable. Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic...... mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (poperative groin hernia...

Quality of life differences in patients with right- versus left-sided facial paralysis: Universal preference of right-sided human face recognition.

Science.gov (United States)

Ryu, Nam Gyu; Lim, Byung Woo; Cho, Jae Keun; Kim, Jin

2016-09-01

We investigated whether experiencing right- or left-sided facial paralysis would affect an individual's ability to recognize one side of the human face using hybrid hemi-facial photos by preliminary study. Further investigation looked at the relationship between facial recognition ability, stress, and quality of life. To investigate predominance of one side of the human face for face recognition, 100 normal participants (right-handed: n = 97, left-handed: n = 3, right brain dominance: n = 56, left brain dominance: n = 44) answered a questionnaire that included hybrid hemi-facial photos developed to determine decide superiority of one side for human face recognition. To determine differences of stress level and quality of life between individuals experiencing right- and left-sided facial paralysis, 100 patients (right side:50, left side:50, not including traumatic facial nerve paralysis) answered a questionnaire about facial disability index test and quality of life (SF-36 Korean version). Regardless of handedness or hemispheric dominance, the proportion of predominance of the right side in human face recognition was larger than the left side (71% versus 12%, neutral: 17%). Facial distress index of the patients with right-sided facial paralysis was lower than that of left-sided patients (68.8 ± 9.42 versus 76.4 ± 8.28), and the SF-36 scores of right-sided patients were lower than left-sided patients (119.07 ± 15.24 versus 123.25 ± 16.48, total score: 166). Universal preference for the right side in human face recognition showed worse psychological mood and social interaction in patients with right-side facial paralysis than left-sided paralysis. This information is helpful to clinicians in that psychological and social factors should be considered when treating patients with facial-paralysis. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias

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Balázs Kovács

2018-01-01

Full Text Available Objectives. Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs. Methods. A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. “U” figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted. Results. No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement. Conclusion. Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.

Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction.

Science.gov (United States)

Kaufman, Matthew R; Elkwood, Andrew I; Colicchio, Alan R; CeCe, John; Jarrahy, Reza; Willekes, Lourens J; Rose, Michael I; Brown, David

2014-01-01

Unilateral diaphragmatic paralysis causes respiratory deficits and can occur after iatrogenic or traumatic phrenic nerve injury in the neck or chest. Patients are evaluated using spirometry and imaging studies; however, phrenic nerve conduction studies and electromyography are not widely available or considered; thus, the degree of dysfunction is often unknown. Treatment has been limited to diaphragmatic plication. Phrenic nerve operations to restore diaphragmatic function may broaden therapeutic options. An interventional study of 92 patients with symptomatic diaphragmatic paralysis assigned 68 (based on their clinical condition) to phrenic nerve surgical intervention (PS), 24 to nonsurgical (NS) care, and evaluated a third group of 68 patients (derived from literature review) treated with diaphragmatic plication (DP). Variables for assessment included spirometry, the Short-Form 36-Item survey, electrodiagnostics, and complications. In the PS group, there was an average 13% improvement in forced expiratory volume in 1 second (p Phrenic nerve operations for functional restoration of the paralyzed diaphragm should be part of the standard treatment algorithm in the management of symptomatic patients with this condition. Assessment of neuromuscular dysfunction can aid in determining the most effective therapy. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Clinicoradiological Diagnosis of Cough-Induced Intercostal Hernia

African Journals Online (AJOL)

Additional CT of the abdomen was performed, and it showed the eighth rib fracture, the torn intercostal muscles, and no diaphragmatic defect [Figure 2]. Physical examination revealed an obese patient who had a soft, nontender, reducible mass on the lateral aspect. (midclavicular line to the midaxillary line) of the left-sided.

Athletic pubalgia (sports hernia).

Science.gov (United States)

Litwin, Demetrius E M; Sneider, Erica B; McEnaney, Patrick M; Busconi, Brian D

2011-04-01

Athletic pubalgia or sports hernia is a syndrome of chronic lower abdomen and groin pain that may occur in athletes and nonathletes. Because the differential diagnosis of chronic lower abdomen and groin pain is so broad, only a small number of patients with chronic lower abdomen and groin pain fulfill the diagnostic criteria of athletic pubalgia (sports hernia). The literature published to date regarding the cause, pathogenesis, diagnosis, and treatment of sports hernias is confusing. This article summarizes the current information and our present approach to this chronic lower abdomen and groin pain syndrome. Copyright © 2011 Elsevier Inc. All rights reserved.

'Right-Sided' May-Thurner Syndrome

International Nuclear Information System (INIS)

Abboud, Georges; Midulla, Marco; Lions, Christophe; El Ngheoui, Ziad; Gengler, Laurent; Martinelli, Thomas; Beregi, Jean-Paul

2010-01-01

The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a 'right-sided' May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carried out, with good patency and clinical result at 12-month follow-up.

Vasopressin in perioperative management of congenital ...

African Journals Online (AJOL)

Perioperative care of infants with diaphragmatic hernias can be a challenge because of pulmonary hypertension and systemic hypotension. The objective of this study was to report the usefulness of vasopressin infusion in improving pulmonary and systemic haemodynamics in an infant with congenital diaphragmatic hernia.

Rarity of invasiveness in right-sided infective endocarditis.

Science.gov (United States)

Hussain, Syed T; Shrestha, Nabin K; Witten, James; Gordon, Steven M; Houghtaling, Penny L; Tingleff, Jens; Navia, José L; Blackstone, Eugene H; Pettersson, Gösta B

2018-01-01

The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients. From January 2002 to January 2015, 1292 patients underwent surgery for active IE, 138 right-sided and 1224 left-sided. Among patients with right-sided IE, 131 had tricuspid and 7 pulmonary valve IE; 12% had prosthetic valve endocarditis. Endocarditis-related invasiveness was based on echocardiographic and operative findings. Invasive disease was rare on the right side, occurring in 1 patient (0.72%; 95% confidence interval 0.02%-4.0%); rather, it was limited to valve cusps/leaflets or was superficial. In contrast, IE was invasive in 408 of 633 patients with aortic valve (AV) IE (65%), 113 of 369 with mitral valve (MV) IE (31%), and 148 of 222 with AV and MV IE (67%). Staphylococcus aureus was a more predominant organism in right-sided than left-sided IE (right 40%, AV 19%, MV 29%), yet invasion was observed almost exclusively on the left side of the heart, which was more common and more severe with AV than MV IE and more common with prosthetic valve endocarditis than native valve IE. Rarity of right-sided invasion even when caused by S aureus suggests that invasion and development of cavities/"abscesses" in patients with IE may be driven more by chamber pressure than organism, along with other reported host-microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin

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Yamazaki Hidehiro

2006-03-01

Full Text Available Abstract Background Metastatic hernia sac tumor from biliary malignancy is extremely rare with only one such case previously reported. We herein report an additional case of extrahepatic cholangiocarcinoma presenting as a hernia sac tumor. Case presentation A 78-year-old man presented with an irreducible right inguinal hernia associated with a firm tumor, 2.0 cm in diameter. A computed tomography scan demonstrated a soft tissue density mass with heterogeneous enhancement within the right inguinal canal. The patient underwent a hernia repair and the hernia sac tumor was resected. Histological examination of the tumor revealed a metastatic adenocarcinoma suggesting the tumor was of pancreato-biliary origin. Further investigation using imaging studies disclosed a primary tumor in the upper bile duct. The patient died of the disease nine months after the resection. Conclusion Hernia sac tumors should be considered when an irreducible, growing mass appears within an inguinal hernia. Computed tomography may be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.

Amyad's hernia while reparing the bilateral inguinal hernia

OpenAIRE

Arif Aslaner; Tuğrul Çakır; Umut Rıza Gündüz; Burhan Mayir; Nurullah Bülbüller

2015-01-01

Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial

Directory of Open Access Journals (Sweden)

van den Hout Lieke

2011-11-01

Full Text Available Abstract Background Congenital diaphragmatic hernia (CDH is a severe congenital anomaly of the diaphragm resulting in pulmonary hypoplasia and pulmonary hypertension. It is associated with a high risk of mortality and pulmonary morbidity. Previous retrospective studies have reported high frequency oscillatory ventilation (HFO to reduce pulmonary morbidity in infants with CDH, while others indicated HFO to be associated with worse outcome. We therefore aimed to develop a randomized controlled trial to compare initial ventilatory treatment with high-frequency oscillation and conventional ventilation in infants with CDH. Methods/design This trial is designed as a multicentre trial in which 400 infants (200 in each arm will be included. Primary outcome measures are BPD, described as oxygen dependency by day 28 according to the definition of Jobe and Bancalari, and/or mortality by day 28. All liveborn infants with CDH born at a gestational age of over 34 weeks and no other severe congenital anomalies are eligible for inclusion. Parental informed consent is asked antenatally and the allocated ventilation mode starts within two hours after birth. Laboratory samples of blood, urine and tracheal aspirate are taken at the first day of life, day 3, day 7, day 14 and day 28 to evaluate laboratory markers for ventilator-induced lung injury and pulmonary hypertension. Discussion To date, randomized clinical trials are lacking in the field of CDH. The VICI-trial, as the first randomized clinical trial in the field of CDH, may provide further insight in ventilation strategies in CDH patient. This may hopefully prevent mortality and morbidity. Trial registration Netherlands Trial Register (NTR: NTR1310

Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia.

Science.gov (United States)

Chan, Kin Wai Edwin; Lee, Kim Hung; Tam, Yuk Him; Sihoe, Jennifer Dart Yin; Cheung, Sing Tak; Mou, Jennifer Wai Cheung

2011-10-01

The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children. A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010. There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy. Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting. Copyright © 2011 Elsevier Inc. All rights reserved.

Amyad's hernia while reparing the bilateral inguinal hernia

Directory of Open Access Journals (Sweden)

Arif Aslaner

2015-01-01

Full Text Available Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

Laparoscopic management of diaphragmatic endometriosis by three different approaches.

Science.gov (United States)

Roman, Horace; Darwish, Basma; Provost, Delphine; Baste, Jean-Marc

2016-08-01

To report our three surgical approaches in the management of diaphragmatic endometriosis. Video article presenting laparoscopic surgical techniques, with and without robotic assistance. University hospital. Nulliparas with deep endometriosis associated with multiple endometriosis lesions of the diaphragm. Laparoscopic approach in women who present with small black-pigmented diaphragmatic lesions, with or without infiltration of the diaphragm, which are ablated using plasma energy. Robotic-assisted laparoscopic route in larger deep infiltrating implants, which are resected. To avoid phrenic nerve injury, robotic-assisted thoracoscopy is preferred in large lesions involving the central tendon of the diaphragm. The steps of each technique are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. Seven patients have been managed by these procedures from July 2015 to March 2016. Patients' functional outcomes were uneventful, with no phrenic nerve palsy or residual chest and right shoulder pain. By combining resection and ablation techniques, the laparoscopy and thoracoscopy route, conventional and robotic-assisted minimally invasive approach, we offer a surgical strategy that is as conservative as possible, with an aim to limit postoperative adhesions between the liver and the diaphragm, and avoid diaphragmatic paralysis. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces

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Yiji Suh

2017-09-01

Full Text Available Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the Petit's triangle or the Grynfeltt-Lesshaft triangle. Clinicians are generally unfamiliar with the presentation of lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Prompt failure to diagnose and surgically correct lumbar hernias have resulted in increased morbidity. This review addresses the anatomical and clinical concepts associated with the bilateral costoiliac spaces, which may be implicated in the increased prevalence of left-sided hernias. Knowledge of the contents and boundaries of this enclosure can aid the physician in diagnosis. We explore the intraperitoneal and retroperitoneal diseases that present at the lumbocostal space, including lumbar hernias, which can be classified as congenital, acquired, traumatic, or iatrogenic in origin. In an evaluation, imaging is crucial for assessing musculofascial layer disruptions and hernia contents. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in surgical intervention, particularly if there are challenges in preliminary pain management. Keywords: Lumbar hernia, Costoiliac spaces, Petit's triangle, Grvnfeltt-lesshaft triangle, Lumbocostovertebral syndrome

Preoperative diagnosis of Amyand's hernia by ultrasound and computed tomography

Directory of Open Access Journals (Sweden)

Husam Vehbi

2016-06-01

Full Text Available Inguinal hernia is the most common seen groin hernias which mostly contain bowel. The incidence of vermiform appendix in an inguinal hernia is seen in 1% of all inguinal hernia. This is known as Amyand's hernia. Appendix within a hernia can be normal or complicated by appendicitis. Most of these cases are not diagnosed preoperatively and managed during surgery. Preoperative diagnosis of these cases is so rare. Very few cases have been reported so far.In our case, we diagnosed an inflamed appendix in a 49 years old female within right inguinal hernia by using ultrasound and confirmed it by CT scan. Keywords: Amyand's hernia, Appendicitis

Right-sided infective endocarditis: recent epidemiologic changes

Science.gov (United States)

Yuan, Shi-Min

2014-01-01

Background: Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE. Methods: Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature. Results: Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients’ survival. Conclusions: Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before. PMID:24482708

Incidence of Important Hemobilia Following Transhepatic Biliary Drainage: Left-Sided Versus Right-Sided Approaches

International Nuclear Information System (INIS)

Rivera-Sanfeliz, G. M.; Assar, O. S. A.; LaBerge, J. M.; Wilson, M. W.; Gordon, R. L.; Ring, E. J.; Kerlan, R. K. Jr.

2004-01-01

Our purpose here is to describe our experience with important hemobilia following PTBD and to determine whether left-sided percutaneous transhepatic biliary drainage (PTBD) is associated with an increased incidence of important hemobilia compared to right-sided drainages. We reviewed 346 transhepatic biliary drainages over a four-year period and identified eight patients (2.3%) with important hemobilia requiring transcatheter embolization. The charts and radiographic files of these patients were reviewed. The side of the PTBD (left versus right), and the order of the biliary ductal branch entered (first, second, or third) were recorded. Of the 346 PTBDs, 269 were right-sided and 77 were left-sided. Of the eight cases of important hemobilia requiring transcatheter embolization, four followed right-sided and four followed left-sided PTBD, corresponding to a bleeding incidence of 1.5% (4/269) for right PTBD and 5.2% (4/77) for left PTBD. The higher incidence of hemobilia associated with left-sided PTBD approached, but did not reach the threshold of statistical significance (p = 0.077). In six of the eight patients requiring transcatheter embolization, first or second order biliary branches were accessed by catheter for PTBD. All patients with left-sided bleeding had first or proximal second order branches accessed by biliary drainage catheters. In conclusion, a higher incidence of hemobilia followed left- versus right-sided PTBD in this study, but the increased incidence did not reach statistical significance

Rarity of invasiveness in right-sided infective endocarditis

DEFF Research Database (Denmark)

Hussain, Syed T; Shrestha, Nabin K; Witten, James

2018-01-01

OBJECTIVE: The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients. PATIENTS AND METHODS: From January 2002 to January 20...

Lumbar hernia - a case report and review of the literature

International Nuclear Information System (INIS)

D'Ippolito, Giuseppe; Yonamine, Claudia

1999-01-01

The authors present a case of lumbar hernia of inferior right space (Petit's triangle), classified as acquired hernia and diagnosed by clinical history and computed tomography. Lumbar hernia are quite rare. Authors have done a literature review of this disease. (author)

A Study of Clinicopathological Differences Between Right-sided and Left-sided Colon Cancers

OpenAIRE

芳賀, 駿介; 遠藤, 俊吾; 加藤, 博之; 高橋, 直樹; 吉松, 和彦; 橋本, 雅彦; 石橋, 敬一郎; 梅原, 有弘; 横溝, 肇; 梶原, 哲郎; Shunsuke, HAGA; Shungo, ENDO; Hiroyuki, KATO; Naoki, TAKAHASHI; Kazuhiko, YOSHIMATSU

1996-01-01

The present study was aimed to determine the clinicopathological features of cancers of the right-sided colon (cecum, ascending colon, transverse colon) and left-sided colon (descending colon, sigmoid colon) in order to help improve the efficacy of their treatment. Excluding multiple cancer cases, 364 patients with primary colon cancer underwent surgey at our department between 1974 and 1994; they comprised 171 individuals with right-sided colon cancer and 193 with left-sided colon cancer. A ...

Amyand\\'s Hernia - A Case Report | Nimako | African Journal of ...

African Journals Online (AJOL)

The finding of a vermiform appendix as the content of an inguinal hernia sac is rare. Even rarer is the finding of an inflamed appendix in the hernia sac, referred to asAmyand\\'s hernia.We report a case of a 5-year-old boy who presented with an inflamed appendix as the content of an incarcerated right inguinal hernia.

Laparoscopic management of a newborn with a right Amyand's ...

African Journals Online (AJOL)

After unsuccessful manual reduction, we decided to perform laparoscopic herniorrhaphy. Laparoscopic examination showed a left hernia with intestinal loops that entered into the internal inguinal ring, on the right side there was an unknown patency of the peritoneal vaginal duct with the appendix completely incarcerated ...

Repair of an inguinoscrotal hernia in a patient with Becker muscular dystrophy.

Science.gov (United States)

Tatulli, F; Caraglia, A; Delcuratolo, A; Cassano, S; Chetta, G S

2017-01-01

Inguinal hernia repairs are routinely performed as outpatient procedures in most patients, whereas a few require admission due to clinical or social peculiarities. Muscular dystrophies are inherited disorders characterized by progressive muscle wasting and weakness. In case of surgery there is no definite recommendation for either general or regional anesthesia. This contribution regards a 48 y. o. male patient diagnosed with Becker Muscular Dystrophy by muscle biopsy 10 years earlier. He had a left-sided sizable inguinoscrotal hernia with repeat episodes of incarceration. An elective mesh repair with suction drainage was accomplished under selective spinal anesthesia. The post-operative course was uneventful. A few inguinal hernia repairs require admission due to peculiarities such as extensive scrotal hernias requiring suction drainage. Muscular dystrophies are inherited disorders with no cure and no two dystrophy patients are exactly alike, therefore the health issues will be different for each individual. In case of surgery there is no definite recommendation for either general or regional anesthesia. This contribution regards the successful elective mesh repair with suction drainage of a large left-sided inguino-scrotal hernia in a 48 y. o. male patient affected by Becker muscular dystrophy by selective spinal anesthesia obtained by 10 milligrams of hyperbaric bupivacaine. Effective mesh repair with suction drainage of large inguinal hernias under spinal anesthesia can be achieved in patients affected by muscular dystrophy.

Prevalence of Birth Defects Among Infants of Gulf War Veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993

Science.gov (United States)

2003-01-01

0 Gastroschisis 0 0 Omphalocele 0 1 5.0 (0.3-32.3) Diaphragmatic hernia 0 0 Down syndrome 0 1 5.0 (0.3-32.3) Trisomy 13 0 0 Trisomy 18 0 0 Chromosomal...0 Gastroschisis 1 1.5 (0.1-9.5) 9 5.0 (2.5-9.9) 0.3 (0.04-2.3) Omphalocele 1 1.5 (0.1-9.5) 0 Diaphragmatic hernia 0 1 0.6 (0.03-3.6) Down syndrome 9...33.1) Omphalocele 0 0 Diaphragmatic hernia 0 0 Down syndrome 1 32.5 (1.7-209) 0 Trisomy 13 0 1 5.1 (0.3-33.1) Trisomy 18 0 0 Chromosomal anomaliesd 0

The management of sportsman's groin hernia in professional and amateur soccer players: a revised concept.

Science.gov (United States)

Kopelman, D; Kaplan, U; Hatoum, O A; Abaya, N; Karni, D; Berber, A; Sharon, P; Peskin, B

2016-02-01

Chronic groin pain appears in athletes with a diverse etiology. In a select few, it can be defined as a sportsman's hernia, that may be related, among other pathologies, to weakness of the posterior inguinal wall and may successfully respond to surgery. Surgical repair of the sportsman's hernia is associated with good functional outcomes, if the diagnosis is based on meticulous examination and follows a simple selection flowchart. Prospective case cohort study. The study assessed patients recruited from 2006 until the present assessed by a dedicated team with clinical and radiographic features of a sportsman's hernia who had failed a specified period of conservative therapies. Surgery was performed using a tension-free mesh open inguinal hernia repair. Of 246 male patients with chronic groin pain, 51 underwent surgery (mean age 20.7 years, range 14-36 years) with 58 inguinal procedures performed. Of the operated group, seven underwent bilateral surgery with a direct hernia found in 9/58 operated sides (15.5%), an indirect hernial sac in 8/58 (14%) and a direct and indirect hernia being found in 3/58 (5%) of operated sides. There was no post-operative morbidity (median follow-up 36.1 months; range 1-74 months), with two failures (3.45 % of operated sides). All other patients were asymptomatic, returned to full sports activity within 4.3 weeks (range 3-8 weeks) after surgery, and required no analgesics or further treatment. Selective surgical hernia repair, based on meticulous anamnesis and physical examination is effective in the management of chronic groin pain in athletes.

Pre-operative Spermatic Cord Ultrasonography Helps to Reduce the Incidence of Metachronous Inguinal Hernia in Boys

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Shoujiang Huang

2018-06-01

Full Text Available Background/purpose: Thickening of the spermatic cord is a clinical sign of an inguinal hernia. We therefore tested whether pre-operative spermatic cord ultrasonography could reduce the incidence of metachronous inguinal hernia (MIH.Methods: Boys under 2 years old with an initial unilateral inguinal hernia were enrolled in this study. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, these patients underwent contralateral groin exploration. Age at initial operation, weight, initial operation side, the sonographic width of the spermatic cord, the operative findings and presence of MIH were recorded, and the relationship among them was studied. Boys in the US group underwent an open herniorrhaphy with pre-operative ultrasound examination; the non-US group included boys who did not undergo a pre-operative ultrasound examination. A receiver operator curve (ROC analysis was performed to evaluated predictive value of the sonographic width of the spermatic cord for contralateral hernia.Results: A total of 24 months' follow-up data were obtained from 1,793 boys (US group 1,162, non-US group 631. In the US group, the width of the hernia-sided spermatic cord (0.75 ± 0.18 cm was larger than the normal side (0.37 ± 0.05 cm, P < 0.001. And the width of normal side spermatic cord had no significant difference between the groups regarding other factors such as age and weight. In whom the width of the asymptomatic-sided spermatic cord was ≥0.5 cm, the corresponding incidence of CIH was 86.4% (57/66. The width of the spermatic cord predicted the presence of contralateral hernia with ROC area under the curve = 0.943 (95% CI = 0.919–0.966. The total incidence of MIH was 4.1% (74/1793. The incidence of MIH in the US group was 2.2% (25/1162 much lower than 7.8% (49/631 in the non-US group (P < 0.001. If the width of the asymptomatic-sided spermatic cord was 0.5 cm and 0.54 cm, the corresponding sensitivity was 0.682 and 0

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature.

Science.gov (United States)

Nuño-Guzmán, Carlos M; Arróniz-Jáuregui, José; Espejo, Ismael; Valle-González, Jesús; Butus, Hernán; Molina-Romo, Alejandro; Orranti-Ortega, Rodrigo I

2012-01-10

Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to

Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature

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Nuño-Guzmán Carlos M

2012-01-01

Full Text Available Abstract Introduction Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature. Case presentation A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health. Conclusions The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and

Post-operative internal hernia through an orifice underneath the right common iliac artery after Dargent's operation.

Science.gov (United States)

Ardelt, M; Dittmar, Y; Scheuerlein, H; Bärthel, E; Settmacher, U

2014-01-01

We report the case of a 39-year-old woman with ileus resulting from a small bowel incarceration underneath the right common iliac artery. The patient had a history of a radical trachelectomy with laparoscopic pelvic lymphadenectomy ("Dargent's operation") for cervical carcinoma. After dissection of the iliac vessels, a small bowel loop could slide underneath the common iliac artery. The hernia was closed by gluing a collagen patch over the right common iliac artery onto the retroperitoneal cavity. To our knowledge, such a case has not previously been reported in the medical literature.

21 CFR 882.5830 - Implanted diaphragmatic/phrenic nerve stimulator.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted diaphragmatic/phrenic nerve stimulator... Implanted diaphragmatic/phrenic nerve stimulator. (a) Identification. An implanted diaphragmatic/phrenic nerve stimulator is a device that provides electrical stimulation of a patient's phrenic nerve to...

Re-expansion pulmonary oedema - differential lung ventilation comes to the rescue

Directory of Open Access Journals (Sweden)

Shreepathi K Achar

2014-01-01

Full Text Available Re-expansion pulmonary oedema (REPE is a rare complication following re-inflation of a chronically collapsed lung, which is often fatal. We present a case of a 22-year-old male who presented to the hospital with severe respiratory distress and a history of blunt abdominal trauma 3 months back. He was diagnosed to have left sided diaphragmatic hernia with a mediastinal shift to the right, and was posted for emergency repair of the same. After surgical decompression of the left hemi-thorax and reduction of the abdominal contents, re-expansion of the left lung was achieved, following which patient developed REPE. A left sided double lumen tube was then inserted to prevent flooding and cross contamination of the right lung and ventilation of both lungs was maintained intraoperatively. Post-operatively, REPE was successfully managed by differential lung ventilation with a lung salvage strategy to the left lung and a lung protective strategy to the right lung.

Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

Directory of Open Access Journals (Sweden)

Chun EM

2015-01-01

Full Text Available Eun Mi Chun,1 Soo Jeong Han,2 Hitesh N Modi3 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea; 2Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea; 3Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea Background: The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD, using a fluoroscopy-guided chest X-ray.Patients and methods: Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.Results: There were significant improvements (2,022.8±1,548.3 mm² to 3,010.7±1,495.6 mm² and 2,382.4±1,475.9 mm² to 3,315.9±1,883.5 mm²; right side P=0.001 and left side P=0.019, respectively in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.Conclusion: The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary

Hérnia diafragmática traumática

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Gerson Alves Pereira Júnior

Full Text Available Traumatic diaphragmatic hernia is an uncommon but important problem in the patient with multiple injuries. Since diaphragmatic injuries are difficult to diagnose, those that are missed may present with latent symptoms of bowel obstruction and strangulation. The same may occur in the patients with stab wounds to the lower chest. Traumatic diaphragmatic hernia should be suspected on the basis of an abnormal chest radiograph in the trauma victim with multiple injuries. This article discuss about history, epidemiology, clinical signs and symptoms, diagnostic modalities, treatment and complications.

Lung MRI and impairment of diaphragmatic function in Pompe disease

DEFF Research Database (Denmark)

Wens, Stephan C A; Ciet, Pierluigi; Perez-Rovira, Adria

2015-01-01

Background: Pompe disease is a progressive metabolic myopathy. Involvement of respiratory muscles leads to progressive pulmonary dysfunction, particularly in supine position. Diaphragmatic weakness is considered to be the most important component. Standard spirometry is to some extent indicative ...... tool to visualize diaphragmatic dynamics in Pompe patients and to study chest-walland diaphragmatic movements in more detail. Our data indicate that diaphragmatic displacement may be severely disturbed in patients with Pompe disease....

Clinical study on 44 cases of femoral hernia

International Nuclear Information System (INIS)

Yamamoto, Ryo; Shinozaki, Hiroharu; Kase, Kenichi; Kobayashi, Kenji; Sasaki, Junichi

2012-01-01

Femoral hernia is a surgical disease that is frequently associated with incarceration and necessitates emergency surgery. However, there are only a few studies referred which have compared emergency and elective surgery for femoral hernias. We retrospectively reviewed the clinical characteristics of patients diagnosed as having femoral hernia between 2005 and 2009 in our institution. The clinical features of emergency repairs were compared with those of elective ones, and diagnostic values of preoperative diagnostic modalities were studied. The mean age of the patients was 73±12 years. Females comprised 68% of the cases, and right femoral hernias comprised 70% of the cases. Incarceration was associated with 66% of the cases (29 patients), and emergency surgery was performed in 52% of the patients (23 patients). Bowel resection was performed in 32% of the cases (14 patients). The mean age, body temperature, white blood cell (WBC) count, and LDH value were higher in the emergency repairs than in the elective one, and most of the hernias were repaired with McVay's procedure. CT scans had a high diagnostic value in detecting femoral hernias (44%) and incarceration (88%). It was confirmed that femoral hernias were frequently associated with incarceration and CT scan has a high diagnostic value in femoral hernias. (author)

Strangulated spigelian hernia

International Nuclear Information System (INIS)

Amin, F.M.; Sultan, T.

2004-01-01

Spigelian hernia is a rare ventral hernia. Strangulation is Spigelian hernia is common but still seen very rarely in clinical practice. We report a case of strangulated Spigelian hernia in an elderly women which was managed satisfactory and the patient discharged on ninth post operative day. (author)

Factors associated with lumbar disc hernia recurrence after microdiscectomy.

Science.gov (United States)

Camino Willhuber, G; Kido, G; Mereles, M; Bassani, J; Petracchi, M; Elizondo, C; Gruenberg, M; Sola, C

Lumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Lumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. 177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. Previous studies show increased disc height and young patients as possible factors associated with recurrence. In our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

32 CFR 935.131 - Right-hand side of the road.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Right-hand side of the road. 935.131 Section 935... INSULAR REGULATIONS WAKE ISLAND CODE Motor Vehicle Code § 935.131 Right-hand side of the road. Each person driving a motor vehicle on Wake Island shall drive on the right-hand side of the road, except where...

Male gender and prematurity are risk factors for incarceration in pediatric inguinal hernia: A study of 922 children

Directory of Open Access Journals (Sweden)

Amine Ksia

2017-01-01

Conclusion: IH occurs mainly in male infants. Prematurity and male gender were identified as risk factors of incarceration. Contralateral metachronous hernia was reported, especially in female infants and after a left side surgical repair of the hernia.

Ectopic Intrathoracic Hepatic Tissue and Accessory Lung Lobe Aplasia in a Dog.

Science.gov (United States)

Lande, Rachel; Dvorak, Laura; Gardiner, David W; Bahr, Anne

2015-01-01

A 6 yr old male Yorkshire terrier was presented for an ~6 yr history of progressive cough and dyspnea. Thoracic radiographs revealed a 6 cm diameter mass within the right caudal thorax. Thoracic ultrasound identified an intrathoracic mass ultrasonographically consistent with liver tissue and a chronic diaphragmatic hernia was suspected. Exploratory laparotomy was performed, but no evidence of a diaphragmatic hernia was identified. Thoracic exploration identified abnormal lung parenchyma. The accessory lung lobe was removed using a stapling devise near its base. The consolidated mass had the gross appearance of liver and was histologically identified as ectopic hepatic tissue. Ectopic hepatic tissue, unlike ectopic splenic and pancreatic tissue, is rare and generally has a subdiaphragmatic distribution. This solitary case report demonstrates that ectopic intrathoracic hepatic tissue should be considered a differential diagnosis for a caudal mediastinal mass.

Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

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Reza Bagheri

2013-12-01

Full Text Available Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery, and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS, etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients and almost occurred on the left side (in 15 patients. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the

Evaluation of the kinesthetic sense and function of the hand in early period in operated cervical disc hernia.

Science.gov (United States)

Kara, Býlge; Yildirim, Yücel; Karadýbak, Dýdem; Acar, Umýt

2006-06-01

A prospective study made into cervical disc hernias. To determine the kinesthetic sense and hand functions, which are important for the patients with cervical disc hernia to return to work life and daily activities that need skill. Neurosurgical department. Data Symptoms in cervical disc hernias and hand functions are affected depending on long-term pain. The evaluation of the hand is essential in assessing the patients' overall recovery and ability to return to daily activities and work life. Thirty-four patients with cervical disc hernia, who were operated on, were included in the study. Eight different test positions in the assessment of the hand's kinesthetic sense and hand function sort (HFS) in the evaluation of the hand function were applied. The disability levels of the patients were determined with The Neck Pain and Disability Scale, on the preoperative and postoperative discharge day and in the postoperative second month. Patients were divided into groups according to the side involved. In the evaluation of the kinesthetic test of the hand, only in the postoperative second month was a significant difference observed between the 1, 2, 3, and 4 test positions of the right side of the groups. On the other hand, no significant difference was found between the groups in the assessment of the hand function. In the measurement of hand functions and disability levels, strong and important correlations were determined. An early assessment of the hand's kinesthetic sense and function is instrumental in the patients' evaluation of recovery and resumption of work.

Posterior diaphragmatic defect detected on chest CT: the incidence according to age and the lateral chest radiographic appearances

International Nuclear Information System (INIS)

Lee, Son Youl; Choi, Yo Won; Jeon, Seok Chol; Heo, Jeong Nam; Park, Choong Ki

2007-01-01

We wanted to investigate the incidence of posterior diaphragmatic defect on chest CT in various age groups and its lateral chest radiographic appearances. The chest CT scans of 78 patients of various ages with posterior diaphragmatic defect were selected among 1,991 patients, and they were analyzed for the incidence of defect in various age groups, the defect location and the herniated contents. Their lateral chest radiographs were analyzed for the shape of the posterior diaphragm and the posterior costophrenic sulcus. The patients' ages ranged from 34 to 87 with the tendency of a higher incidence in the older patients. The defect most frequently involved the medial two thirds (n = 49, 50.4%) and middle one third (n = 36, 37%) of the posterior diaphragm. The retroperitoneal fat was herniated into the thorax through the defect in all patients, and sometimes with the kidney (n = 8). Lateral chest radiography showed a normal diaphragmatic contour (n = 51, 49.5%), blunting of the posterior costophrenic sulcus (n = 41, 39.8%), focal humping of the posterior diaphragm (n = 7, 6.8%), or upward convexity (n = 4, 3.9%) of the posterior costophrenic sulcus on the affected side. The posterior diaphragmatic defect discovered in asymptomatic patients who are without a history of peridiaphragmatic disease is most likely acquired, and this malady increases in incidence according to age. An abnormal contour of the posterior diaphragm or the costophrenic sulcus on a lateral chest radiograph may be a finding of posterior diaphragmatic defect

Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair.

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Pawanindra Lal; Philips, Prejesh; Chander, Jagdish; Ramteke, Vinod K

2010-07-01

Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic TEP in all cases and to compare complications, recurrence rates, postoperative pain, patient satisfaction, and return to work retrospectively with a similar number of age-matched retrospective controls. One hundred fifty TEP operations were performed in 75 patients (group A) prospectively and were compared with 75 unilateral TEP operations (group B) in age-matched controls done previously by the same surgeon. All cases were performed under general anesthesia, and TEP repair was performed using three midline ports. All uncomplicated patients were discharged at 24 h, in keeping with departmental policy. Of 75 patients (group A), 25 (33.3%) were clinically diagnosed with bilateral hernia and the rest (50, 66.66%) with unilateral hernia. The distribution of the 25 bilateral cases was 11 bilateral direct and 14 bilateral indirect inguinal hernias. The distribution of the 75 age-matched controls (group B) was all unilateral hernia, of which 47 were right-sided and 28 were left-sided. There were 23 direct hernias and 52 indirect hernias among the control group. The mean operative time for all 150 cases was 76.66 +/- 15.92 min. The operative time in the control group (unilateral hernias) was 66.16 +/- 12.44 min, whereas the operative time in the test group (bilateral repair) was 87.2 +/- 11.32 min. The operative time in the bilateral group was significantly higher, by 21.04 min or 31.88% (p = 0.000). The operative time in the true unilateral group was 82.45 +/- 9.38 min, whereas the operative time in the former

OUTCOMES OF SURGICAL TREATMENT OF HIATAL HERNIA

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Zhurbenko G. A.

2018-05-01

Full Text Available Background: In traditionally performed fundoplications during the treatment of sliding diaphragmatic hernias, the improvement of surgical techniques to restore acute angle of His remains topical. Aim: To develop a method of surgical treatment of hiatus hernias to restore acute angle of His. Material and methods: Patients (n = 74 were divided into two groups: the main group (I (n = 45, in which the developed operation method was applied and the control group (II (n = 29, in which Toupet method was applied to 26 patients, Nissen method – to 3 patients. GERD-Q and GERD-HRQL questionnaires were applied to all patients of the first group before the operation, during discharge from hospital and 6-12 12-18 18-24 months after surgical intervention. Patients of the second group were surveyed 6-12 months after the operation. Results: According to the results of the survey after 6-12 months statistically significant differences were not revealed in the groups: GERD-Q, p<0,386; GERD-HRQL, p<0,1089. In the main group there was a tendency to decrease the points in the GERD-Q survey when compared before and after surgery, p <0.0001. Out of 16 (55% patients of the second group hospitalized after the operation the relapse was revealed in 9 patients, 7 of them were re-operated. 20(43,3% patients of group I underwent inpatient examination, 2 relapsed and no one was re-operated. Conclusion: The efficiency of the suggested operation technique is comparable to Toupet method in the early stages, although when assessing the remote results there are a less number of relapses.

Adult abdominal hernias.

LENUS (Irish Health Repository)

Murphy, Kevin P

2014-06-01

Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

Etiology of Inguinal Hernias

DEFF Research Database (Denmark)

Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

2017-01-01

BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral...... and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared...... mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor....

An Evaluation of Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative.

Science.gov (United States)

Fox, Sarah S; Janczyk, Randy; Warren, Jeremy A; Carbonell, Alfredo M; Poulose, Benjamin K; Rosen, Michael J; Hope, William W

2017-08-01

The purpose of this review was to evaluate outcomes relating to parastomal hernia repair. Data from the Americas Hernia Society Quality Collaborative were used to identify patients undergoing parastomal hernia repair from 2013 to 2016. Parastomal hernia repairs were compared with other repairs using Pearson's test and Wilcoxon test with a P value Ostomy disposition included ostomy left in situ (47%), moved to a new site (18%), taken down (22%), and rematured in same location in (13%). Outcomes related to parastomal hernia repair included 10 per cent surgical site infection, 24 per cent surgical site occurrence, and 12 per cent surgical site occurrences requiring procedural interventions with a 13 per cent readmission rate and 6 per cent reoperation rate. When comparing parastomal hernias with other ventral hernia repairs, parastomal hernias had a significantly higher surgical site infection, surgical site occurrence, surgical site occurrences requiring procedural intervention, readmission, reoperation rate, and length of stay, and were less commonly performed laparoscopically (P < 0.05). Most parastomal hernias are being repaired open with synthetic mesh in the sublay position. Less favorable outcomes of parastomal hernia repair when compared with other ventral hernia repairs are likely related to the complexity of parastomal hernia repair.

Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch

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Ming-Yen Ng

2014-01-01

Full Text Available We present a 31-year-old female with repaired tetralogy of Fallot (TOF and right-sided aortic arch (RAA with left-sided patent ductus arteriosus (PDA originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature.

Presentations of agenesis of the hemidiaphragm in an adult

International Nuclear Information System (INIS)

Izeldin, Osama M.; Ahmed, Mohamed E.

2008-01-01

A 67-year-old man was presented with chest tightness and vomiting of one-week duration. On physical examination bowel sounds were heard on the left chest. Plain chest x-ray, barium swallow and CT gastric scan suggested volvulus with diaphragmatic hernia. At laparotomy there was complete agenesis of the left hemidiaphragm with no diaphragmatic remnants seen and no associated lung hypoplasia. This is an extremely rare condition and careful assessment is needed to differentiate between diaphragmatic hernia and agenesis of diaphragm as more cases could be diagnosed in the future as a result of good perinatal care of agenesis of hemidiaphragm (AHD) and long term survival to adulthood. (author)

Right Ear Advantage of Speech Audiometry in Single-sided Deafness.

Science.gov (United States)

Wettstein, Vincent G; Probst, Rudolf

2018-04-01

Postlingual single-sided deafness (SSD) is defined as normal hearing in one ear and severely impaired hearing in the other ear. A right ear advantage and dominance of the left hemisphere are well established findings in individuals with normal hearing and speech processing. Therefore, it seems plausible that a right ear advantage would exist in patients with SSD. The audiometric database was searched to identify patients with SSD. Results from the German monosyllabic Freiburg word test and four-syllabic number test in quiet were evaluated. Results of right-sided SSD were compared with left-sided SSD. Statistical calculations were done with the Mann-Whitney U test. Four hundred and six patients with SSD were identified, 182 with right-sided and 224 with left-sided SSD. The two groups had similar pure-tone thresholds without significant differences. All test parameters of speech audiometry had better values for right ears (SSD left) when compared with left ears (SSD right). Statistically significant results (p right and 97.5 ± 4.7% left, p right and 93.9 ± 9.1% left, p right and 63.8 ± 11.1 dB SPL left, p right ear advantage of speech audiometry was found in patients with SSD in this retrospective study of audiometric test results.

An incarcerated Amyand’s hernia: Shall we apply appendectomy routinely?

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Gökhan Demiral

2018-03-01

Full Text Available Amyand’s hernia is a very rare clinical condition characterized by the presence of a normal or inflammed appendix within the inguinal hernia sac. It may be present as an acute apendicitis inside the sac or incarcerated hernia. Sometimes it may be asymptomatic. We report a case of 70-year-old male patient that was presented to our emergency service with a huge right inguinal mass that was diagnosed as an incarcerated inguinal hernia and underwent operation. The intraoperative findings included small intestinal segment, large omental tissue and mobile cecum with healthy appendix inside the sac. There was no sign of strangulation. Lichtenstein herniorhaphy was done without appendectomy.

Comparison between the incidence of right and left sided congenital torticollis

International Nuclear Information System (INIS)

Aslam, S.; Bashir, M.S.; Hussain, S.I.

2013-01-01

Congenital torticollis is an intriguing condition of unknown origin, characterized by unilateral shortening and tightness of the sternocleidomastoid muscle. Patients usually present with head tilt, facial asymmetry and plagiocephaly. A sternomastoid mass or tumor may or may not be clinically apparent. Untreated, cervical function and facial cosmesis may be severely compromised. Objective: My study is aimed at establishing a comparison between the incidence of right versus left sided congenital torticollis. Method: This observational study included 30 patients of congenital torticollis that completed the questionnaire. The data was collected from patients coming to the Physiotherapy and Orthopedic departments of Children Hospital, Lahore. Results: Results showed that right side was involved in 19 (63.3%) patients and left side was involved in 11 (36.7%) patients. Out of 30 patients, 14 (46.7%) were male, of which 8 had right sided congenital torticollis and 6 had left sided congenital torticollis, and 16 (53.3%) were female, of which right sided congenital torticollis and 5 had left sided congenital torticollis. Conclusion: Hence it is concluded that incidence of right sided congenital torticollis is more common than left sided congenital torticollis. The incidence of con-genital torticollis is higher in females than in males. (author)

Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair

DEFF Research Database (Denmark)

Henriksen, Nadia A; Sorensen, Lars T; Bay-Nielsen, Morten

2013-01-01

A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim...

Etiology of Inguinal Hernias

DEFF Research Database (Denmark)

Öberg, Stina; Andresen, Kristoffer; Rosenberg, Jacob

2017-01-01

BACKGROUND: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. RESULTS: Lateral a...

Large Ventral Hernia

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Meryl Abrams, MD

2018-04-01

Full Text Available History of present illness: A 46-year-old female presented to the emergency department (ED with diffuse abdominal pain and three days of poor oral intake associated with non-bilious, non-bloody vomiting. Initial vital signs consisted of a mild resting tachycardia of 111 with a temperature of 38.0 degrees Celsius (°C. On examination, the patient had a large pannus extending to the knees, which contained a hernia. She was tender in this region on examination. Laboratory values included normal serum chemistries and mild leukocytosis of 12.2. The patient reports that her abdomen had been enlarging over the previous 8 years but had not been painful until 3 days prior to presentation. The patient had no associated fever, chills, diarrhea, constipation, chest pain or shortness of breath. Significant findings: Computed tomography (CT scan with intravenous (IV contrast of the abdomen and pelvis demonstrated a large pannus containing a ventral hernia with abdominal contents extending below the knees (white circle, elongation of mesenteric vessels to accommodate abdominal contents outside of the abdomen (white arrow and air fluid levels (white arrow indicating a small bowel obstruction. Discussion: Hernias are a common chief complaint seen in the emergency department. The estimated lifetime risk of a spontaneous abdominal hernia is 5%.1 The most common type of hernia is inguinal while the next most common type of hernia is femoral, which are more common in women.1 Ventral hernias can be epigastric, incisional, or primary abdominal. An asymptomatic, reducible hernia can be followed up as outpatient with a general surgeon for elective repair.2 Hernias become problematic when they are either incarcerated or strangulated. A hernia is incarcerated when the hernia is irreducible and strangulated when its blood supply is compromised. A complicated hernia, especially strangulated, can have a mortality of greater than 50%.1 It is key to perform a thorough history

Unusual variant of Cantrell′s pentalogy?

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Kumar Basant

2008-01-01

Full Text Available A 12-hour-old male infant presented with prolapsed abdominal content through a defect on left side of chest wall with respiratory distress. A thorough clinical examination suggested absence of ectopia cordis, abdominal wall defect, and any bony anomaly. The child expired after 6 hours of admission because of respiratory distress and electrolyte imbalance. Is congenital defect of chest wall associated with diaphragmatic hernia without ectopia cordis and omphalocele, an unusual variant of Cantrell′s pentalogy?

Incidental De Garengeot's hernia: A case report of dual pathology to remember.

Science.gov (United States)

Whitehead-Clarke, Thomas; Parampalli, Umesh; Bhardwaj, Rakesh

2015-01-01

A De Garengeot's hernia is the very rare dual pathology of a vermiform appendix within a femoral hernia. We discuss the rare case of a 62 year old female who presented as an emergency with a strangulated femoral hernia. Within the hernia sac a partly necrotic vermiform appendix was discovered. The patient successfully underwent an appendicectomy and repair of her femoral hernia. The post-operative period was uneventful, with no further issues at follow-up. Our case report displays the successful treatment of a De Garengeot's hernia as an emergency admission, with a shorter than average admission time, and no post-operative complications. This is a rare case of dual pathology, of which we believe there are few published cases. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Right-sided vagus nerve stimulation inhibits induced spinal cord seizures.

Science.gov (United States)

Tubbs, R Shane; Salter, E George; Killingsworth, Cheryl; Rollins, Dennis L; Smith, William M; Ideker, Raymond E; Wellons, John C; Blount, Jeffrey P; Oakes, W Jerry

2007-01-01

We have previously shown that left-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. To test our hypothesis that right-sided vagus nerve stimulation will also abort seizure activity, we have initiated seizures in the spinal cord and then performed right-sided vagus nerve stimulation in an animal model. Four pigs were anesthetized and placed in the lateral position and a small laminectomy performed in the lumbar region. Topical penicillin, a known epileptogenic drug to the cerebral cortex and spinal cord, was next applied to the dorsal surface of the exposed cord. With the exception of the control animal, once seizure activity was discernible via motor convulsion or increased electrical activity, the right vagus nerve previously isolated in the neck was stimulated. Following multiple stimulations of the vagus nerve and with seizure activity confirmed, the cord was transected in the midthoracic region and vagus nerve stimulation performed. Right-sided vagus nerve stimulation resulted in cessation of spinal cord seizure activity in all animals. Transection of the spinal cord superior to the site of seizure induction resulted in the ineffectiveness of vagus nerve stimulation in causing cessation of seizure activity in all study animals. As with left-sided vagus nerve stimulation, right-sided vagus nerve stimulation results in cessation of induced spinal cord seizures. Additionally, the effects of right-sided vagus nerve stimulation on induced spinal cord seizures involve descending spinal pathways. These data may aid in the development of alternative mechanisms for electrical stimulation for patients with medically intractable seizures and add to our knowledge regarding the mechanism for seizure cessation following peripheral nerve stimulation.

Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture

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Iclal Ocak

2016-01-01

Full Text Available Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. In recent years, multidetector CT has markedly improved the diagnosis of diaphragmatic injury in polytrauma patients. Herein, we describe two cases of subacute presentation of traumatic diaphragmatic rupture from a penetrating rib fracture and subsequent intrathoracic herniation of omental fat, representing the CT “funky fat” sign.

A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

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Mustafa Hasbahceci

2014-01-01

Full Text Available Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided in 39 patients with a mean age of 48.8±15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1±22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%. Conversion to open surgery was necessitated in 7 cases (16.7%. After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P=0.130 and all conversions (P=0.001 occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

[Tension gastrothorax as a cause of death by obstructive shock - case report].

Science.gov (United States)

García-Regalado, Juan F; Navarro-Rojas, Mariana M

2014-07-01

Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type. Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax. A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm. The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.

Tension pneumothorax due to perforated colon.

Science.gov (United States)

Abdullah, Muhammad; Stonelake, Paul

2016-05-31

A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation. 2016 BMJ Publishing Group Ltd.

A rare case of Amyand’s hernia presenting as an enterocutaneous fistula

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L Flood

2010-09-01

Full Text Available The finding of the vermiform appendix in an inguinal hernia has an incidence of approximately 1%. The condition is given the eponymous name Amyand’s hernia. However in just 0.08% the condition is complicated by an acute appendicitis. The clinical presentation varies, depending on the extent of inflammation of the appendix and is most often misdiagnosed as an incarcerated inguinal hernia. As such it is rarely recognised prior to surgical exploration. We report a case of Amyand’s hernia in an 85 year old woman, which presented as a right groin enterocutaneous fistula. CT scanning illustrated a fistulous tract in the right groin, which communicated with the caecum and the peritoneal cavity. She underwent laparotomy, which revealed that the appendix appeared inflamed, lay in the inguinal canal and was the origin of the enterocutaneous communication.

Bullhorn Hernia: A Rare Traumatic Abdominal Wall Hernia

African Journals Online (AJOL)

Department of Surgery, Government Medical College and Rajindra. Hospital, Patiala ‑ 147 001, Punjab, India. E‑mail: drbimal.undefined@gmail.com. INTRODUCTION. Traumatic abdominal wall hernia (TAWH) is uncommonly encountered despite the high prevalence of blunt abdominal trauma.[1] Bullhorn hernia is a rare, ...

European Hernia Society guidelines on prevention and treatment of parastomal hernias.

Science.gov (United States)

Antoniou, S A; Agresta, F; Garcia Alamino, J M; Berger, D; Berrevoet, F; Brandsma, H-T; Bury, K; Conze, J; Cuccurullo, D; Dietz, U A; Fortelny, R H; Frei-Lanter, C; Hansson, B; Helgstrand, F; Hotouras, A; Jänes, A; Kroese, L F; Lambrecht, J R; Kyle-Leinhase, I; López-Cano, M; Maggiori, L; Mandalà, V; Miserez, M; Montgomery, A; Morales-Conde, S; Prudhomme, M; Rautio, T; Smart, N; Śmietański, M; Szczepkowski, M; Stabilini, C; Muysoms, F E

2018-02-01

International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of

Inversion of the radionuclide regurgitant index in right-sided valvular regurgitation

Energy Technology Data Exchange (ETDEWEB)

Novack, H.; Machac, J.; Horowitz, S.F.

1985-11-01

Estimation of left-sided valvular insufficiency has been obtained using the ratio of left- to right-ventricular stroke counts, i.e., the regurgitant index. The present study was designed to evaluate the usefulness of the regurgitant index in identifying patients with isolated right-sided valvular insufficiency. We identified 12 patients with tricuspid or pulmonic regurgitation by at least two of the following criteria: (1) pulsatile liver, (2) positive Carvallo's sign, and (3) pulsatile jugular-venous distension. In 9 of the 12 patients, the right-sided insufficiency was confirmed by catheterization or contrast echocardiography and flow-directed pulsed-echo Doppler. The regurgitant index in patients with right-sided insufficiency was 0.59 +- 0.23. This was significantly different from patients with left-sided insufficiency (3.09 +- 0.8) and from control subjects (1.49 +- 0.32). In 11 of the 12 patients with right-sided regurgitant lesions, the regurgitant index was less than 1.0. The hepatic expansion fraction, a possible correlate of an expansile liver, has previously been found to be both sensitive and specific for the detection of patients with right-sided regurgitation. We calculated the hepatic expansion fraction in 6 patients with tricuspid regurgitation (including 3 with pulsatile livers) and 5 controls using the method of Handler et al.. In the present study, the hepatic expansion fraction in tricuspid-insufficiency patients was 4.3% as compared to 4.1% in normals (P=NS). In summary, this study suggests that the regurgitant index may be a sensitive tool for the diagnosis of right-sided regurgitant lesions, while the hepatic expansion fraction does not appear to be useful for identifying tricuspid insufficiency.

Inversion of the radionuclide regurgitant index in right-sided valvular regurgitation

International Nuclear Information System (INIS)

Novack, H.; Machac, J.; Horowitz, S.F.; Mount Sinai Medical Center, New York

1985-01-01

Estimation of left-sided valvular insufficiency has been obtained using the ratio of left- to right-ventricular stroke counts, i.e., the regurgitant index. The present study was designed to evaluate the usefulness of the regurgitant index in identifying patients with isolated right-sided valvular insufficiency. We identified 12 patients with tricuspid or pulmonic regurgitation by at least two of the following criteria: (1) pulsatile liver, (2) positive Carvallo's sign, and (3) pulsatile jugular-venous distension. In 9 of the 12 patients, the right-sided insufficiency was confirmed by catheterization or contrast echocardiography and flow-directed pulsed-echo Doppler. The regurgitant index in patients with right-sided insufficiency was 0.59+-0.23. This was significantly different from patients with left-sided insufficiency (3.09+-0.8; P<0.001) and from control subjects (1.49+-0.32; P<0.001). In 11 of the 12 patients with right-sided regurgitant lesions, the regurgitant index was less than 1.0. The hepatic expansion fraction, a possible correlate of an expansile liver, has previously been found to be both sensitive and specific for the detection of patients with right-sided regurgitation. We calculated the hepatic expansion fraction in 6 patients with tricuspid regurgitation (including 3 with pulsatile livers) and 5 controls using the method of Handler et al.. In the present study, the hepatic expansion fraction in tricuspid-insufficiency patients was 4.3% as compared to 4.1% in normals (P=NS). In summary, this study suggests that the regurgitant index may be a sensitive tool for the diagnosis of right-sided regurgitant lesions, while the hepatic expansion fraction does not appear to be useful for identifying tricuspid insufficiency. (orig.)

A case report of a de Garengeot hernia in a nonagenarian veteran

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Luis R. Taveras

Full Text Available Introduction: A hernia containing the vermiform appendix [de Garengeot hernia (DGH] is an exceedingly rare event. Appendicitis occurring in this setting if further unusual. Most cases of DGH are made during inguinal exploration. In the present report, we discuss a patient who underwent an operation which revealed a DGH with appendicitis. Presentation of a case: A 94-year-old man with a past medical history significant for hypertension and Parkinson’s disease was admitted to the hospital for the management of an event of CHF exacerbation. He developed acute onset of a painful right inguinal bulge. He had no prior hernia history. On physical exam, he had a 3-cm, tender, non-reducible right inguinal bulge without skin changes. Laboratory analyses were normal without leukocytosis. An acute abdominal series was obtained and demonstrated no obstruction. A groin exploration was performed under local anesthetic. An abscess was found associated with a femoral hernia containing the vermiform appendix. An appendectomy was performed through the hernia sac. The hernia was repaired via a McVay technique. At thirty days after his procedure, he had no complications and no signs of recurrence. Conclusion: Most cases of DGH are diagnosed intraoperatively. Limited work up might be sufficient for adequate management. Several surgical strategies are acceptable. Groin exploration, plus and minus an appendectomy, and tissue repair versus mesh placement are acceptable surgical strategies. Laparoscopic approach for the management of DGH has been reported. Keywords: Femoral hernia, Groin hernia, Appendicitis, Case report

Persisting asymmetries of vision after right side lesions

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Habekost, Thomas; Rostrup, Egill

2006-01-01

Visual neglect and extinction are well-known effects of lesions in the right hemisphere. This study shows that even with minor or no clinical signs of these deficits, and in the stable phase of recovery, asymmetric visual perception is common after right side lesions. Whole, partial and colour...... report experiments were used to estimate psychophysical parameters related to visual capacity and attentional weighting in 26 patients with stroke in the right side of the brain. The results were analyzed using Bundesen's Theory of Visual Attention (TVA [Bundesen, C. (1990). A theory of visual attention....... Psychological Review, 97, 523-547]) including bootstrap estimation of the measurement error related to each test result [Habekost, T., & Bundesen, C. (2003). Patient assessment based on a theory of visual attention (TVA): Subtle deficits after a right frontal-subcortical lesion. Neuropsychologia, 41, 1171...

Cervical lung hernia

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Lightwood, Robin G.; Cleland, W. P.

1974-01-01

Lightwood, R. G., and Cleland, W. P. (1974).Thorax, 29, 349-351. Cervical lung hernia. Lung hernias occur in the cervical position in about one third of cases. The remainder appear through the chest wall. Some lung hernias are congenital, but trauma is the most common cause. The indications for surgery depend upon the severity of symptoms. Repair by direct suture can be used for small tears in Sibson's (costovertebral) fascia while larger defects have been closed using prosthetic materials. Four patients with cervical lung hernia are described together with an account of their operations. PMID:4850946

Incisional hernia prevention and use of mesh. A narrative review.

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Hernández-Granados, Pilar; López-Cano, Manuel; Morales-Conde, Salvador; Muysoms, Filip; García-Alamino, Josep; Pereira-Rodríguez, José Antonio

2018-02-01

Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Drainage of pleural effusion improves diaphragmatic function in mechanically ventilated patients.

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Umbrello, Michele; Mistraletti, Giovanni; Galimberti, Andrea; Piva, Ilaria R; Cozzi, Ottavia; Formenti, Paolo

2017-03-01

Pleural effusion adversely affects the pressuregenerating capacity of the diaphragm. It uncouples the lung and chest wall, which may result in diaphragmatic dysfunction. Information on the effects of effusion drainage on diaphragmatic function is limited, but several studies report relief of dyspnoea after drainage, which was attributed to improved diaphragmatic mechanics, even if this issue was never formally addressed. To investigate the effect of drainage of unilateral pleural effusion on diaphragmatic function. In a prospective twostep protocol (at baseline and after drainage of effusion), we conducted a spontaneous breathing trial in fourteen critically ill, mechanically ventilated patients undergoing pressure support ventilation. We used ultrasonography of the ipsilateral hemidiaphragm to evaluate and record respiratory displacement and thickening during tidal and maximal breathing efforts. We recorded and analysed airway pressures, respiratory system compliance, vital capacity, indices of respiratory effort and arterial blood gases. After drainage of the effusion, the respiratory rate decreased and tidal volume increased, but haemodynamic parameters were unaffected and oxygenation levels showed a non-significant increase. Drainage was associated with significant decreases in indices of respiratory drive and the maximal pressure generated by the respiratory muscles, as well as an increased compliance of the respiratory system. Diaphragmatic displacement and thickening significantly increased after drainage. We found there was a significant correlation between the volume of the effusion drained and the increase in tidal diaphragmatic thickening. Drainage of a unilateral pleural effusion during weaning from mechanical ventilation improves diaphragmatic contractile activity and respiratory system performance.

Indentation in the Right Ventricle by an Incomplete Pericardium on 3-Dimensional Reconstructed Computed Tomography

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Hak Ju Kim

2017-08-01

Full Text Available We report the case of a 17-year-old girl who presented with an indentation in the right ventricle caused by an incomplete pericardium on preoperative 3-dimensional reconstructed computed tomography. She was to undergo surgery for a partial atrioventricular septal defect and secundum atrial septal defect. Preoperative electrocardiography revealed occasional premature ventricular beats. We found the absence of the left side of the pericardium intraoperatively, and this absence caused strangulation of the diaphragmatic surface of the right ventricle. After correcting the lesion, the patient’s rhythm disturbances improved.

Groin hernia subtypes are associated in patients with bilateral hernias

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Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian

2015-01-01

repair (89.9% males) were registered, and of those were 12,041 persons operated bilaterally (94.9% males). Females and males operated for a unilaterally direct inguinal hernia (DIH) had increased Hazard Ratios (HR) of 3.85 (CI 95% 2.14-6.19) and 4.46 (CI 95% 2.57-7.88) of being contralaterally operated...... for a DIH. Females and males operated for a unilaterally indirect inguinal hernia (IIH) had HRs of 6.93 (CI 95% 3.66-13.11) and 1.89 (CI95% 1.24-2.88) for being contralaterally operated for an IIH. The same tendency was seen for femoral hernias. CONCLUSIONS: All hernia subtypes were bilaterally associated...

[Amyand's hernia--a clinical case].

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Savlovschi, C; Brănescu, C; Serban, D; Tudor, C; Găvan, C; Shanabli, A; Comandaşu, M; Vasilescu, L; Borcan, R; Dumitrescu, D; Sandolache, B; Sajin, M; Grădinaru, S; Munteanu, R; Kraft, A; Oprescu, S

2010-01-01

Amyand's hernia, a rare entity in the surgical pathology, presupposes the presence of the vermiform appendix inside a inguinal hernia sac (1). The hernia sac peritonitis by appendix swelling is even more rare, very few cases being presented in the surgical literature (1). The preoperatory diagnosis of Amyand's hernia is therefore very difficult. We herein present the case of a 71-year old male patient, operated on an emergency basis for hernia, which eventually turned out to be Amyand's hernia, a case which determined us to research the literature dedicated to this topic.

Amyand's hernia masquerading inguinal abscess complicated with appendico-cutaeneous fistula in an infant with Hirschsprung's disease

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Ruzaimie Noor

2017-06-01

Full Text Available A normal or diseased vermiform appendix located inside the inguinal hernia is called Amyand's hernia (AH. The incidence of appendicitis in Amyand's hernia is rare. The appendicitis per se is uncommon disease in infancy. We reported an extremely rare case of undiagnosed right Amyand's hernia mimicking inguinal abscess complicated with appendico-cutaneous fistula in total colonic Hirschsprung's Disease.

A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

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Cem Sahin

2015-01-01

Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

Laparoscopic Repair of Sportman's Hernia - The Trinidad Experience.

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Gopeesingh, Anyl; Dan, Dilip; Naraynsingh, Vijay; Hariharan, Seetharaman; Seetahal, Shiva

2014-01-01

Sportman's hernia: (Athletic pubalgia) is an uncommon and poorly understood condition afflicting athletic individuals. Sufferers complain of chronic groin pain and often present diagnostic dilemmas to physicians and physiotherapists. We present a series of cases illustrating the varying presentations of sportman's hernia and diagnostic approaches that can be utilized to exclude common differentials. We also describe laparoscopic mesh repair as an effective treatment option for this condition. © 2013 National Medical Association. Published by Elsevier Inc. All rights reserved.

No inherent left and right side in human 'mental number line': evidence from right brain damage.

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Aiello, Marilena; Jacquin-Courtois, Sophie; Merola, Sheila; Ottaviani, Teresa; Tomaiuolo, Francesco; Bueti, Domenica; Rossetti, Yves; Doricchi, Fabrizio

2012-08-01

Spatial reasoning has a relevant role in mathematics and helps daily computational activities. It is widely assumed that in cultures with left-to-right reading, numbers are organized along the mental equivalent of a ruler, the mental number line, with small magnitudes located to the left of larger ones. Patients with right brain damage can disregard smaller numbers while mentally setting the midpoint of number intervals. This has been interpreted as a sign of spatial neglect for numbers on the left side of the mental number line and taken as a strong argument for the intrinsic left-to-right organization of the mental number line. Here, we put forward the understanding of this cognitive disability by discovering that patients with right brain damage disregard smaller numbers both when these are mapped on the left side of the mental number line and on the right side of an imagined clock face. This shows that the right hemisphere supports the representation of small numerical magnitudes independently from their mapping on the left or the right side of a spatial-mental layout. In addition, the study of the anatomical correlates through voxel-based lesion-symptom mapping and the mapping of lesion peaks on the diffusion tensor imaging-based reconstruction of white matter pathways showed that the rightward bias in the imagined clock-face was correlated with lesions of high-level middle temporal visual areas that code stimuli in object-centred spatial coordinates, i.e. stimuli that, like a clock face, have an inherent left and right side. In contrast, bias towards higher numbers on the mental number line was linked to white matter damage in the frontal component of the parietal-frontal number network. These anatomical findings show that the human brain does not represent the mental number line as an object with an inherent left and right side. We conclude that the bias towards higher numbers in the mental bisection of number intervals does not depend on left side spatial

Preperitoneal approach to parastomal hernia with coexistent large incisional hernia.

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Egun, A; Hill, J; MacLennan, I; Pearson, R. C

2002-03-01

OBJECTIVE: To assess the outcome of preperitoneal mesh repair of complex incisional herniae incorporating a stoma and large parastomal hernia. METHODS: From 1994 to 1998, symptomatic patients who had repair of combined incisional hernia and parastomal hernia were reviewed. Body mass index, co-morbidity, length of hospital stay, patient satisfaction and outcomes were recorded. RESULTS: Ten patients (seven females and three males), mean age 62 (range 48-80) years underwent primary repair. All had significant comorbidities (ASA grade 3) and mean body mass index was 31.1 (range 20-49). Median hospital stay was 15 (range 8-150) days. Complications were of varying clinical significance (seroma, superficial infection, major respiratory tract infection and stomal necrosis). There were no recurrences after a mean follow up of 54 (range 22-69) months. CONCLUSION: The combination of a parastomal hernia and generalised wound dehiscence is an uncommon but difficult problem. The application of the principles of low-tension mesh repair can provide a satisfactory outcome and low recurrence rate. This must be tempered by recognition of the potential for significant major postoperative complication.

Early hemi-diaphragmatic plication following intraoperative phrenic nerve transection during complete AV canal repair

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Hamad Alowayshiq

2018-04-01

Full Text Available Unilateral diaphragmatic palsy reduces pulmonary function by about 25% in older children and usually it is well tolerated; however, it causes severe respiratory distress in infants and young children. Diaphragmatic plication performed later than 10 days after cardiac surgery for patients under 1 year of age was associated with higher incidence of pneumonia and mortality. The management of the diaphragmatic paralysis due to phrenic nerve injury aiming mainly to preserve the respiratory function. Until now, the optimal management of diaphragmatic palsy in children who have undergone cardiac surgery remains controversial and consists of prolonged ventilation or diaphragmatic plication. In our case, many factors supported early diaphragmatic plication, the age of the patient, post-operative AV canal repair with severe pulmonary hypertension, and clear transection of the left phrenic nerve diagnosed intraoperatively.

Abdominal wall hernias: computed tomography findings; Hernias da parede abdomino-pelvica: aspectos tomograficos

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D' Ippolito, Giuseppe; Rosas, George de Queiroz; Mota, Marcos Alexandre; Akisue, Sandra R. Tsukada; Galvao Filho, Mario de Melo[Hospital e Maternidade Sao Luiz, Sao Paulo, SP (Brazil). Setor de US/TC/RMN]. E-mail: giuseppe_dr@uol.com.br

2005-07-15

Abdominal hernias are a common clinical problem Clinical diagnosis of abdominal hernias can sometimes be challenging, particularly in obese patients or patients with previous abdominal surgery. CT scan of the abdomen allows visualization of hernias and their contents and the differentiation from other masses of the abdominal wall such as tumors, hematomas and abscesses. Moreover, CT may identify complications such as incarceration, bowel obstruction, volvulus and strangulation. This study illustrates the CT scan findings observed in different types of abdominal wall hernias. (author)

Large Hiatal Hernia Compressing the Heart.

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Matar, Andrew; Mroue, Jad; Camporesi, Enrico; Mangar, Devanand; Albrink, Michael

2016-02-01

We describe a 41-year-old man with De Mosier's syndrome who presented with exercise intolerance and dyspnea on exertion caused by a giant hiatal hernia compressing the heart with relief by surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Hernias (For Parents)

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... look like inguinal hernias, but are not: A communicating hydrocele is similar to a hernia, except that ... reviewed: September 2016 More on this topic for: Parents Kids Teens Medical Care and Your Newborn Undescended ...

Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years.

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Dulucq, Jean-Louis; Wintringer, Pascal; Mahajna, Ahmad

2009-03-01

Two revolutions in inguinal hernia repair surgery have occurred during the last two decades. The first was the introduction of tension-free hernia repair by Liechtenstein in 1989 and the second was the application of laparoscopic surgery to the treatment of inguinal hernia in the early 1990s. The purposes of this study were to assess the safety and effectiveness of laparoscopic totally extraperitoneal (TEP) repair and to discuss the technical changes that we faced on the basis of our accumulative experience. Patients who underwent an elective inguinal hernia repair at the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS), Bordeaux, between June 1990 and May 2005 were enrolled retrospectively in this study. Patient demographic data, operative and postoperative course, and outpatient follow-up were studied. A total of 3,100 hernia repairs were included in the study. The majority of the hernias were repaired by TEP technique; the repair was done by transabdominal preperitoneal (TAPP) repair in only 3%. Eleven percent of the hernias were recurrences after conventional repair. Mean operative time was 17 min in unilateral hernia and 24 min in bilateral hernia. There were 36 hernias (1.2%) that required conversion: 12 hernias were converted to open anterior Liechtenstein and 24 to laparoscopic TAPP technique. The incidence of intraoperative complications was low. Most of the patients were discharged at the second day of the surgery. The overall postoperative morbidity rate was 2.2%. The incidence of recurrence rate was 0.35%. The recurrence rate for the first 200 repairs was 2.5%, but it decreased to 0.47% for the subsequent 1,254 hernia repairs According to our experience, in the hands of experienced laparoscopic surgeons, laparoscopic hernia repair seems to be the favored approach for most types of inguinal hernias. TEP is preferred over TAPP as the peritoneum is not violated and there are fewer intra-abdominal complications.

[Hiatal hernias: why and how should they be surgically treated].

Science.gov (United States)

Braghetto, Italo; Csendes, Attila; Korn, Owen; Musleh, Maher; Lanzarini, Enrique; Saure, Alex; Hananias, Baydir; Valladares, Héctor

2013-01-01

There is controversy in the literature about the choice of expectant medical treatment versus surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. A total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. In 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (p<.05). Type iv hernias (complex) and those with diameters measuring more than 16 cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type iv complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type iii hernia and severe oesophagitis required reoperation. We recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

Amyand’s hernia with acute gangrenous appendicitis and cecal perforation: A case report and review of the literature

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William Kromka

Full Text Available Introduction: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. Presentation of case: A 46-year-old male with a right inguinal hernia of 2–3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain. The patient was diagnosed with an incarcerated right inguinal hernia and underwent emergent surgical repair. Intraoperatively a reactive fluid was found within the hernia sac that prompted an exploratory laparotomy for suspected bowel perforation. The hernia was then found to contain an inflamed gangrenous appendix with an inflamed and perforated cecum. An ileocecectomy and enteroenterostomy was performed and the hernia defect was repaired without mesh. Discussion: With an estimated incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. To avoid potential morbidity and mortality, the surgeon must consider an Amyand's hernia on his or her differential when operating on inguinal hernias and be aware of the associated presentations, complications, and management schemes. Conclusion: There is a paucity of reports describing simultaneous appendicitis and cecal perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini hernia repair with close follow-up led to a favorable outcome. Keywords: Amyand, Hernia, Appendicitis, Surgery, Case report, Ileocecectomy

Laporoscopic Surgery as the Gold Standard Surgery for Inguinal Hernia in Children

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Elena Yu. Dyakonova

2018-01-01

Full Text Available Inguinal hernia in children is one of the most common diseases requiring surgical treatment. There are two methods of surgical interventions for inguinal hernia in children: open and laparoscopic. In international clinical practice, open hernia repair is widely used due to the simplicity of the technique which does not require special tools. However, the percentage of complications and relapse frequency remain high when open hernia repair is performed. The article presents the analysis of the treatment results in 209 children with strangulated inguinal hernia who underwent open and laparoscopic surgery in the period from 2003 to 2014. The open hernia repair (Krasnobaev or Martynov technique was performed in 89 children. The following complications were registered: edema of the spermatic cord — in 34 patients, non-viable loop of the intestine — in 2; one child had a vermicular appendix with signs of striation in the hernial sac, 4 patients — a vermiform appendix with signs of inflammation. In 6 cases the contents of the hernial sac included the strand of the greater omentum, in 1 — the strand of the greater omentum with signs of acute ischemia. In 12 children, the hernial protrusion was absorbed to the abdominal, and therefore no revision was required. In 1 patient, the early postoperative period was complicated by peritonitis due to bowel wall necrosis. Laparoscopic hernioplasty was performed in 120 pediatric patients. The contents of the hernial sac in 86 cases included a loop of the small intestine, in 7 — an appendix and a site of the caecum, in 15 — the ovary and fallopian tubes, in 5 — the strand of the greater omentum. In 14 children, unobliterated internal inguinal rings previously not diagnosed were detected when examining the abdomen. Simultaneous appendectomy was performed when the cecum and the appendix were strangulated. Laparoscopic techniques omitting the disadvantages of an open repair method make it possible to

Ventral hernia repair

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... incarcerated) in the hernia and become impossible to push back in. This is usually painful. The blood supply ... you are lying down or that you cannot push back in. Risks The risks of ventral hernia repair ...

Treating and Preventing Sports Hernias

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... Close ‹ Back to Healthy Living Treating and Preventing Sports Hernias If you play ice hockey, tennis or ... for the most commonly misdiagnosed groin pain—a sports hernia. A sports hernia often results from overuse ...

Combined atresia of one left-sided and one right-sided cardiac valve in a premature newborn.

Science.gov (United States)

Roberts, William C; Sing, Alan C; Guileyardo, Joseph M

2017-10-01

Described herein is the heart of a 2-day-old newborn, the product of a 25-week gestation, with atresia of two cardiac valves, one on the right side and one on the left side, apparently a previously undescribed entity.

Etiology of Inguinal Hernias: A Comprehensive Review

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Stina Öberg

2017-09-01

Full Text Available BackgroundThe etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias.ResultsLateral and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue homeostasis.ConclusionThe etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor.

The Danish Inguinal Hernia Database

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Friis-Andersen H

2016-10-01

Full Text Available Hans Friis-Andersen1,2, Thue Bisgaard2,3 1Surgical Department, Horsens Regional Hospital, Horsens, Denmark; 2Steering Committee, Danish Hernia Database, 3Surgical Gastroenterological Department 235, Copenhagen University Hospital, Hvidovre, Denmark Aim of database: To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Study population: Patients ≥18 years operated for groin hernia. Main variables: Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. Descriptive data: According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time. All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. Results: The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015. A total of 49 peer-reviewed national and international publications have been published from the database (June 2015. Conclusion: The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair. Keywords: nation-wide, recurrence, chronic pain, femoral hernia, surgery, quality improvement

Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children.

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Zhou, Xuewu; Peng, Lei; Sha, Yongliang; Song, Daiqiang

2014-01-01

To describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. In our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. The TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25-40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. Our preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results. Published by Elsevier Inc.

Abdominal wall hernia and pregnancy

DEFF Research Database (Denmark)

Jensen, K K; Henriksen, N A; Jorgensen, L N

2015-01-01

PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions.

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Faucheron, J-L; Paquette, B; Trilling, B; Heyd, B; Koch, S; Mantion, G

2018-02-01

Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers. Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected. There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher. Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor.

Left Paraduodenal Hernia: An Autopsy Case

DEFF Research Database (Denmark)

Omland, Silje Haukali; Hougen, Hans Petter

2011-01-01

We present a case of a left paraduodenal hernia diagnosed at autopsy. A left paraduodenal hernia is an internal hernia of congenital origin due to the abnormal rotation of the midgut during embryonic development. Internal hernias are a rare cause of intestinal obstruction, with the paraduodenal...

Outpatient repair for inguinal hernia in elderly patients: still a challenge?

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Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco

2014-01-01

Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Drain-Site Hernia Containing the Vermiform Appendix: Report of a Case

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Markus Gass

2013-01-01

Full Text Available The herniated vermiform appendix has been described as content of every hernia orifice in the right lower quadrant. While the femoral and inguinal herniated vermiform appendix is frequent enough to result in an own designation, port-site or even drain-site hernias are less frequently described. We report the case of a 62-year-old woman who presented with right lower quadrant pain seven years after Roux-en-Y Cystojejunostomy for a pancreatic cyst. CT scan showed herniation of the vermiform appendix through a former drain-site. A diagnostic laparoscopy with appendectomy and direct closure of the abdominal wall defect combined with mesh reinforcement was performed. Despite the decreasing use of intraperitoneal drains over the recent years, a multitude of patients had intraperitoneal drainage in former times. These patients face nowadays the risk of drain-site hernias with sometimes even unexpected structures inside.

Systemic and local collagen turnover in hernia patients

DEFF Research Database (Denmark)

Henriksen, Nadia A

2016-01-01

composition appears altered in fascial tissue but also in skin biopsies, suggesting that the collagen alterations are systemic. More pronounced collagen alterations are found in patients with hernia recurrences. Hypothetically, primary inguinal hernias are formed due to a systemic predisposition to altered...... connective tissue, whereas impaired healing influences on the development of incisional hernias and hernia recurrences. The overall objective of this thesis was to investigate the collagen turnover systemically and locally in patients with primary inguinal hernia, multiple hernias and incisional hernia...... repair after adjustment for gender, age and surgical approach. In a multivariable subgroup analysis, direct and recurrent inguinal hernia repair were associated with primary ventral hernia surgery, whereas only recurrent inguinal hernia repair was associated with secondary ventral hernia surgery...

Incarcerated umbilical hernia in children.

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Chirdan, L B; Uba, A F; Kidmas, A T

2006-02-01

Umbilical hernia is common in children. Complications from umbilical hernias are thought to be rare and the natural history is spontaneous closure within 5 years. A retrospective analysis was performed of the medical records of a series of 23 children who presented with incarcerated umbilical hernias at our institution over an 8-year period. Fifty-two children with umbilical hernias were seen in the hospital over the period. Twenty-three (44.2%) had incarceration. Seventeen (32.7%) had acute incarceration while 6 (11.5%) had recurrent incarceration. There were 16 girls and 7 boys. The ages of the children with acute incarceration ranged from 3 weeks to 12 years (median 4 years), while the ages of those with recurrent incarceration ranged from 3-15 years (median 8.5 years). Incarceration occurred in hernias of more than 1.5 cm in diameter (in those whose defect size was measured). Twenty-one children (15 with acute and all six with recurrent incarceration) underwent repair of the umbilical hernia using standard methods. The parents of two children with acute incarceration declined surgery after spontaneous reduction of the hernia in one and taxis in the other. One boy had gangrenous bowel containing Meckel's diverticulum inside the sac, for which bowel resection with end-to-end anastomosis was done. Operation led to disappearance of pain in all 6 children with recurrent incarceration. Superficial wound infection occurred in one child. There was no mortality. Incarcerated umbilical hernia is not as uncommon as thought. Active observation of children with umbilical hernia is necessary to prevent morbidity from incarceration.

Perforated gastric corpus in a strangulated paraesophageal hernia: a case report

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Shafii Alexis E

2009-05-01

Full Text Available Abstract Introduction Patients with paraesophageal hernias often present secondary to chronic symptomatology. Infrequently, acute intestinal ischemia and perforation can occur as a consequence of paraesophageal hernias with potentially dire consequences. Case presentation An 86-year-old obtunded male presented to the emergency department with hypotension and severe back and abdominal pain. An emergency abdominal CT scan was ordered with a presumptive diagnosis of ruptured abdominal aortic aneurysm. CT topograms revealed extensive free intra-abdominal air and herniated abdominal viscera into the right hemithorax. Prior to completion of the CT study, the patient sustained a cardiopulmonary arrest. Surgery was consulted, but the patient was unable to be revived. Post-mortem examination revealed gross contamination within the abdomen and a giant, incarcerated, hiatal hernia with organoaxial volvulus and ischemic perforation. Conclusion Current recommendations call for prompt repair of giant hiatal hernias before they become symptomatic due to the increased risk of strangulation. Torsion of the stomach in large hiatal hernias frequently leads to a fatal complication such as this warranting elective repair as soon as possible.

A pin in appendix within Amyand's hernia in a six-years-old boy: case report and review of literature

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Jashari Hysni J

2010-05-01

Full Text Available Abstract Introduction Presence of vermiform appendix (non-inflamed or inflamed in inguinal hernia is called Amyand's hernia in honor to surgeon C. Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. This presentation of foreign body Amyand's hernia appendicitis is very rare, and here we present such a case. Case presentation A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area. On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long. Conclusion Foreign body (pin Amyand's hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006. In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered. In our case, it is possible that the injury during the football game might have induced perforation of the vermiform appendix with the foreign body in it.

The Danish Inguinal Hernia database.

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Friis-Andersen, Hans; Bisgaard, Thue

2016-01-01

To monitor and improve nation-wide surgical outcome after groin hernia repair based on scientific evidence-based surgical strategies for the national and international surgical community. Patients ≥18 years operated for groin hernia. Type and size of hernia, primary or recurrent, type of surgical repair procedure, mesh and mesh fixation methods. According to the Danish National Health Act, surgeons are obliged to register all hernia repairs immediately after surgery (3 minute registration time). All institutions have continuous access to their own data stratified on individual surgeons. Registrations are based on a closed, protected Internet system requiring personal codes also identifying the operating institution. A national steering committee consisting of 13 voluntary and dedicated surgeons, 11 of whom are unpaid, handles the medical management of the database. The Danish Inguinal Hernia Database comprises intraoperative data from >130,000 repairs (May 2015). A total of 49 peer-reviewed national and international publications have been published from the database (June 2015). The Danish Inguinal Hernia Database is fully active monitoring surgical quality and contributes to the national and international surgical society to improve outcome after groin hernia repair.

A nationwide Danish cohort study challenging the categorisation into right-sided and left-sided colon cancer

DEFF Research Database (Denmark)

Jess, Per; Hansen, Iben Onsberg; Gamborg, Michael

2013-01-01

The categorisation of colon cancer (CC) into right-sided (RCC) and left-sided (LCC) disease may not capture more subtle variances in aetiology and prognosis. In a nationwide study, we investigated differences in clinical characteristics and survival of RCC versus LCC and of the complete range of CC...

US patterns of the diaphragmatic crura. Normal anatomy and its variants; Aspetti ecografici dei pilastri diaframmatici. Anatomia normale e sue varianti

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Crespi, G.; Martinoli, C.; Cicio, G.R. [Genua Univ., Genua (Italy). Cattedra R di Radiologia DICMI; Zappasodi, F. [Sobborgo Valzania, Cesena, FO (Italy); Valle, M. [Istituto Gaslini, Genua (Italy). Servizio di Radiologia

2000-06-01

scans, ranged 3-10 mm in deep inspiration and 1-4 mm in expiration while the left crus was 3-6 mm in inspiration and 1-2 mm in expiration. The length of the right crus, studied in the preaortic portion, ranged form 7 mm in deep inspiration to 9.7 cm in expiration while the left one was 6.5 to 8.8 cm. The right lateral diaphragmatic bundles were seen in 28 subjects only on repeated subcostal oblique scans and the left ones in 11 subjects only. Finally the thin anterior bundles were shown on parasagittal images in 13 cases in the right side and in 2 in the left. A 2-band appearance of the diaphragm was seen 10 patients with pleural effusion and in 8 patients with associated ascites. A single band was found only in the tendinous portion of the diaphragm. US is presently considered the imaging method of choice in the assessment of changes in thickness and length of the diaphragmatic crura. These structures have different US patterns and can sometimes appear quite bulky and thus be easily mistaken for other anatomic or abnormal structures; orthogonal scans may be required for the differential diagnosis. [Italian] Scopo di questo lavoro e' quello di analizzare mediante ecografia, la differente morfologia dei fasci muscolari del diaframma in diverse scansioni e con il variare degli atti respiratori, tenendo conto dell'ampia variabilita' individuale che queste strutture possono presentare. In condizioni normali l'aspetto ecografico del diaframma e' duplice; la porzione tendinea centrale appare come una linea iperecogena, la parte muscolare periferica e' caratterizzata da strutture allungate che assumono morfologia trilaminare nel punto di maggiore spessore. Talvolta lungo il decorso dei pilastri diaframmatici possono presentarsi nodulazioni, reperto che va correttamente identificato al fine di evitare errori interpretativi. Il lavoro e' stato suddiviso in tre parti. Prima si sono esaminate retrospettivamente le immagini di 23 soggetti che

Silver microparticles plus fibrin tissue sealant prevents incisional hernias in rats.

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Primus, Frank E; Young, David M; Grenert, James P; Harris, Hobart W

2018-07-01

Open abdominal surgery is frequently complicated by the subsequent development of an incisional hernia. Consequently, more than 400,000 incisional hernia repairs are performed each year, adding over $15 billion per year to U.S. health-care expenditures. While the vast majority of studies have focused on improved surgical techniques or prosthetic materials, we examined the use of metallic silver microparticles to prevent incisional hernia formation through enhanced wound healing. A rodent incisional hernia model was used. Eighty-two rats were randomly placed into two control groups (saline alone and silver microparticles alone), and three experimental groups (0 mg/cm, 2.5 mg/cm, and 25 mg/cm of silver microparticles applied with a fibrin sealant). Incisional hernia incidence and size, tensile strength, and tissue histology were assessed after 28 days. A significant reduction of both incisional hernia incidence and hernia size was observed between the control groups and 2.5 mg/cm group, and between the control and 25 mg/cm group by nearly 60% and 90%, respectively (P < 0.05). Histological samples showed a noticeable increase in new fibrosis in the treated animals as compared with the controls, whereas the tensile strength between the groups did not differ. The novel approach of using silver microparticles to enhance wound healing appears to be a safe and effective method to prevent incisional hernias from developing and could herald a new era of medicinal silver use. Copyright © 2018 Elsevier Inc. All rights reserved.

A rare localization in right-sided endocarditis diagnosed by echocardiography: A case report

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Beaufils Philippe

2003-08-01

Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. Case presentation A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. Conclusions Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.

The inheritance of groin hernia

DEFF Research Database (Denmark)

Burcharth, J; Pommergaard, H C; Rosenberg, Jacob

2013-01-01

Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias.......Groin hernia has been proposed to be hereditary; however, a clear hereditary pattern has not been established yet. The purpose of this review was to analyze studies evaluating family history and inheritance patterns and to investigate the possible heredity of groin hernias....

Vincent Alexander Bochdalek (1801-1883).

Science.gov (United States)

Loukas, Marios; El-Sedfy, Abraham; Tubbs, R Shane; Gribben, Walter B; Shoja, Mohammadali M; Cermakova, Andrea

2008-10-01

Vincent Alexander Bochdalek, Czech anatomist and professor, was one of the pioneers in describing congenital diaphragmatic hernias in newborns. Interestingly, there is very little in the literature and almost nothing in the English literature regarding this important medical figure. A dedicated individual, Bochdalek had great perseverance, which allowed him to surpass obstacles in both his personal life and career. He is recognized for his accurate description of posterior diaphragmatic herniation, for which during his lifetime, there was no treatment. In addition, Bochdalek has multiple eponyms in his honor: ganglion Bochdalecki, Bochdalek's basket, and the valves of Bochdalek. Always steadfast in his beliefs, Bochdalek fought for the creation of anatomy labs in Prague against society pressures. His devoted study of anatomy, especially of congenital diaphragmatic hernias, laid the foundation for the successful surgical correction of this once lethal anomaly.

Diaphragmatic Hernia After Radiofrequency Ablation for Hepatocellular Carcinoma

International Nuclear Information System (INIS)

Yamagami, Takuji; Yoshimatsu, Rika; Matsushima, Shigenori; Tanaka, Osamu; Miura, Hiroshi; Nishimura, Tsunehiko

2011-01-01

We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.

The case for early use of rapid whole genome sequencing in management of critically ill infants: Late diagnosis of Coffin-Siris syndrome in an infant with left congenital diaphragmatic hernia, congenital heart disease and recurrent infections.

Science.gov (United States)

Sweeney, Nathaly M; Nahas, Shareef A; Chowdhury, Shimul; Del Campo, Miguel; Jones, Marilyn C; Dimmock, David P; Kingsmore, Stephen F; Investigators, Rcigm

2018-03-16

Congenital diaphragmatic hernia (CDH) results from incomplete formation of the diaphragm leading to herniation of abdominal organs into the thoracic cavity. CDH is associated with pulmonary hypoplasia, congenital heart disease and pulmonary hypertension. Genetically, it is associated with aneuploidies, chromosomal copy number variants, and single gene mutations. CDH is the most expensive non-cardiac congenital defect: Management frequently requires implementation of Extracorporeal Membrane Oxygenation (ECMO), which increases management expenditures 2.4 - 3.5-fold. The cost of management of CDH has been estimated to exceed $250 million per year. Despite in hospital survival of 80-90%, current management is imperfect, as a great proportion of surviving children have long-term functional deficits. We report the case of a premature infant prenatally diagnosed with CDH and congenital heart disease, who had a protracted and complicated course in the intensive care unit with multiple surgical interventions, including post-cardiac surgery ECMO, gastrostomy tube placement with Nissen fundoplication, tracheostomy for respiratory failure, recurrent infections and developmental delay. Rapid whole genome sequencing (rWGS) identified a de novo, likely pathogenic, c.3096_3100delCAAAG (p.Lys1033Argfs*32) variant in ARID1B, providing a diagnosis of Coffin-Siris syndrome. Her parents elected palliative care and she died later that day. Had rWGS been performed as a neonate, eight months of suffering and futile healthcare utilization may have been avoided. Cold Spring Harbor Laboratory Press.

[Hernia surgery in urology. Part 2: parastomal, trocar and incisional hernias - fundamentals of clinical diagnostics and treatment].

Science.gov (United States)

Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

2013-06-01

Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.

Inguinal hernia recurrence: Classification and approach

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Campanelli Giampiero

2006-01-01

Full Text Available The authors reviewed the records of 2,468 operations of groin hernia in 2,350 patients, including 277 recurrent hernias updated to January 2005. The data obtained - evaluating technique, results and complications - were used to propose a simple anatomo-clinical classification into three types which could be used to plan the surgical strategy:Type R1: first recurrence ′high,′ oblique external, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R2: first recurrence ′low,′ direct, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R3: all the other recurrences - including femoral recurrences; recurrent groin hernia with big defect (inguinal eventration; multirecurrent hernias; nonreducible, linked with a controlateral primitive or recurrent hernia; and situations compromised from aggravating factors (for example obesity or anyway not easily included in R1 or R2, after pure tissue or mesh repair.

Persisting asymmetries of vision after right side lesions

DEFF Research Database (Denmark)

Habekost, Thomas; Rostrup, Egill

2006-01-01

Visual neglect and extinction are well-known effects of lesions in the right hemisphere. This study shows that even with minor or no clinical signs of these deficits, and in the stable phase of recovery, asymmetric visual perception is common after right side lesions. Whole, partial and colour....... Psychological Review, 97, 523-547]) including bootstrap estimation of the measurement error related to each test result [Habekost, T., & Bundesen, C. (2003). Patient assessment based on a theory of visual attention (TVA): Subtle deficits after a right frontal-subcortical lesion. Neuropsychologia, 41, 1171...

Incarcerated inguinal hernia management in children: 'a comparison of the open and laparoscopic approach'.

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Mishra, Pankaj Kumar; Burnand, Katherine; Minocha, Ashish; Mathur, Azad B; Kulkarni, Milind S; Tsang, Thomas

2014-06-01

To compare the outcomes of management of incarcerated inguinal hernia by open versus laparoscopic approach. This is a retrospective analysis of incarcerated inguinal hernina in a paediatric surgery centre involving four consultants. Manual reduction was attempted in all and failure was managed by emergency surgery. The laparoscopy group had 27 patients. Four patients failed manual reduction and underwent emergency laparoscopic surgery. Three of them had small bowel strangulation which was reduced laparoscopically. The strangulated bowel was dusky in colour initially but changed to normal colour subsequently under vision. The fourth patient required appendectomy for strangulated appendix. One patient had concomitant repair of umbilical hernia and one patient had laparoscopic pyloromyotomy at the same time. One patient had testicular atrophy, one had hydrocoele and one had recurrence of hernia on the asymptomatic side. The open surgery group had 45 patients. Eleven patients had failed manual reduction requiring emergency surgery, of these two required resection and anastomosis of small intestine. One patient in this group had concomitant repair of undescended testis. There was no recurrence in this group, one had testicular atrophy and seven had metachronous hernia. Both open herniotomy and laparoscopic repair offer safe surgery with comparable outcomes for incarcerated inguinal hernia in children. Laparoscopic approach and hernioscopy at the time of open approach appear to show the advantage of repairing the contralateral patent processus vaginalis at the same time and avoiding metachronous inguinal hernia.

Made in Italy for hernia: the Italian history of groin hernia repair.

Science.gov (United States)

Negro, Paolo; Gossetti, Francesco; Ceci, Francesca; D'Amore, Linda

2016-01-01

The history of groin hernia surgery is as long as the history of surgery. For many centuries doctors, anatomists and surgeons have been devoted to this pathology, afflicting the mankind throughout its evolution. Since ancient times the Italian contribution has been very important with many representative personalities. Authors, investigators and pioneers are really well represented. Every period (the classic period, the Middle Age, the Renaissance and the post-Renaissance) opened new perspectives for a better understanding. During the 18th century, more information about groin anatomy, mainly due to Antonio Scarpa, prepared the Bassini revolution. Edoardo Bassini developed the first modern anatomically based hernia repair. This procedure spread worldwide becoming the most performed surgical technique. After World War II synthetic meshes were introduced and a new era has begun for hernia repair, once again with the support of Italian surgeons, first of all Ermanno Trabucco. But Italian contribution extends also to educational, with the first national school for abdominal wall surgery starting in Rome, and to Italian participation and support in international scientific societies. Authors hereby wish to resume this long history highlighting the "made in Italy" for groin hernia surgery. Bassini, Groin hernia, History, Prosthetic repair.

Neonatal extracorporeal membrane oxygenation: Initial experience of Hospital de São João

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G. Rocha

2014-11-01

Full Text Available The purpose of this series is to report the initial ECMO experience of the Neonatal Intensive Care Unit of Hospital de São João. The first three clinical cases are reported. Case report 1: a 39 weeks gestational age girl with severe lung hypoplasia secondary to a bilateral congenital diaphragmatic hernia. Case report 2: a 39 weeks gestational age girl with a right congenital diaphragmatic hernia and a tracheal stenosis. Case report 3: a 34 weeks gestational age boy, with 61 days of life, with a Bordetella pertussis pneumonia, severe pulmonary hypertension, shock, hyperleukocytosis and seizures. Resumo: O objetivo desta série é apresentar a experiência inicial da Unidade de Cuidados Intensivos Neonatais do Hospital de São João com ECMO no recém-nascido. São apresentados os 3 primeiros casos. Caso 1: recém-nascido de 39 semanas de idade gestacional, com hipoplasia pulmonar severa secundária a hérnia diafragmática congénita bilateral. Caso 2: recém-nascido de 39 semanas de idade gestacional, com hérnia diafragmática congénita direita e estenose traqueal. Caso 3: pré-termo de 34 semanas de idade gestacional, sexo masculino, com 61 dias de vida, com pneumonia por Bordetella pertussis, hipertensão pulmonar severa, choque, hiperleucocitose e convulsões. Keywords: Extracorporeal membrane oxygenation, Newborn, Congenital diaphragmatic hernia, Tracheal stenosis, Bordetella pertussis infection, Palavras-chave: Oxigenação por membrana extracorporal, Recém-nascido, Hérnia diafragmática congénita, Estenose traqueal, Infeção por Bordetella pertussis

Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method.

Science.gov (United States)

İnce, E; Temiz, A; Ezer, S S; Gezer, H Ö; Hiçsönmez, A

2017-06-01

Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. We recorded 15 cases of umbilical cord hernias over 10 years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2 ± 2.1 right kidney, left kidney with a duplex system, coarctation of the aorta, ventricular septal defect, meningocele, club foot, and choanal atresia. Surgical exploration was carried out in all of the neonates and they underwent corrective surgery with good outcomes. In an umbilical cord hernia, the body folds develop normally and form the umbilical ring. The double purse-string technique is easy to apply and produces satisfactory cosmetic results in neonates with umbilical cord hernias.

Causes of congenital unilateral pulmonary hypoplasia

International Nuclear Information System (INIS)

Currarino, G.; Williams, B.; Children's Medical Center, Dallas, TX

1985-01-01

A review of the roentgenograms and clinical records of 33 children with primary congenital underdevelopment of one lung showed that 9 patients had simple pulmonary hypoplasia, 8 had anomalous venous return to the right atrium or the inferior vena cava (scimitar syndrome), 7 had an absence of ipsilateral pulmonary artery, 7 had an accessory diaphragm, and 2 had a pulmonary sequestration adjacent to a small diaphragmatic hernia. (orig.)

Laparoscopic repair of large suprapubic hernias.

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Sikar, Hasan Ediz; Çetin, Kenan; Eyvaz, Kemal; Kaptanoglu, Levent; Küçük, Hasan Fehmi

2017-09-01

Suprapubic hernia is the term to describe ventral hernias located less than 4 cm above the pubic arch in the midline. Hernias with an upper margin above the arcuate line encounter technical difficulties, and the differences in repair methods forced us to define them as large suprapubic hernias. To present our experience with laparoscopic repair of large suprapubic hernias that allows adequate mesh overlap. Nineteen patients with suprapubic incisional hernias who underwent laparoscopic repair between May 2013 and January 2015 were included in the study. Patients with laparoscopic extraperitoneal repair who had a suprapubic hernia with an upper margin below the arcuate line were excluded. Two men and 17 women, with a mean age of 58.2, underwent laparoscopic repair. Most of the incisions were midline vertical (13/68.4%). Twelve (63.1%) of the patients had previous incisional hernia repair (PIHR group); the mean number of previous incisional hernia repair was 1.4. Mean defect size of the PIHR group was higher than in patients without previous repair - 107.3 cm 2 vs. 50.9 cm 2 (p < 0.05). Mean operating time of the PIHR group was higher than in patients without repair - 126 min vs. 77.9 min (p < 0.05). Although all complications occurred in the PIHR group, there was no statistically significant difference. Laparoscopic repair of large suprapubic hernias can be considered as the first option in treatment. The low recurrence rates reported in the literature and the lack of recurrence, as observed in our study, support this view.

Unusual cause of brachial palsy with diaphragmatic palsy.

Science.gov (United States)

Gupta, Vishal; Pandita, Aakash; Panghal, Astha; Hassan, Neha

2018-05-12

We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. On examination, there was bilateral congenital talipes equinovarus and a scar was present on the forearm. The mother had a history of chickenpox during the 16 weeks of pregnancy for which no treatment was sought. On investigation, PCR for varicella was found to be positive in the neonate. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Treatment and Controversies in Paraesophageal Hernia Repair

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P. Marco eFisichella

2015-04-01

Full Text Available Background: Historically all paraesophageal hernias were repaired surgically, today intervention is reserved for symptomatic paraesophageal hernias. In this review, we describe the indications for repair and explore the controversies in paraesophageal hernia repair, which include a comparison of open to laparoscopic paraesophageal hernia repair, the necessity of complete sac excision, the routine performance of fundoplication, and the use of mesh for hernia repair.Methods: We searched Pubmed for papers published between 1980 and 2015 using the following keywords: hiatal hernias, paraesophageal hernias, regurgitation, dysphagia, gastroesophageal reflux disease, aspiration, GERD, endoscopy, manometry, pH monitoring, proton pump inhibitors, anemia, iron deficiency anemia, Nissen fundoplication, sac excision, mesh, mesh repair. Results: Indications for paraesophageal hernia repair have changed, and currently symptomatic paraesophageal hernias are recommended for repair. In addition, it is important not to overlook iron-deficiency anemia and pulmonary complaints, which tend to improve with repair. Current practice favors a laparoscopic approach, complete sac excision, primary crural repair with or without use of mesh, and a routine fundoplication.

Modern diagnosis and treatment of hiatal hernias.

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Siegal, Steve R; Dolan, James P; Hunter, John G

2017-12-01

Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias. A literature review of contemporary and latest studies with highest quality of evidence was completed. This information was examined and compiled in review format. Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac, 3 cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure. Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure. Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have reflux disease, an operative repair is required. A minimally invasive approach is safe and has improved outcomes.

Herniography off femoral, obturator and perineal hernias

International Nuclear Information System (INIS)

Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

1985-01-01

Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed. (orig.) [de

Two-dimensional echocardiographic features of right ventricular infarction

International Nuclear Information System (INIS)

D'Arcy, B.; Nanda, N.C.

1982-01-01

Real-time, two-dimensional echocardiographic studies were performed in 10 patients with acute myocardial infarction who had clinical features suggestive of right ventricular involvement. All patients showed right ventricular wall motion abnormalities. In the four-chamber view, seven patients showed akinesis of the entire right ventricular diaphragmatic wall and three showed akinesis of segments of the diaphragmatic wall. Segmental dyskinetic areas involving the right ventricular free wall were identified in four patients. One patient showed a large right ventricular apical aneurysm. Other echocardiographic features included enlargement of the right ventricle in eight cases, paradoxical ventricular septal motion in seven cases, tricuspid incompetence in eight cases, dilation of the stomach in four cases and localized pericardial effusion in two cases. Right ventricular infarction was confirmed by radionuclide methods in seven patients, at surgery in one patient and at autopsy in two patients

Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax

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J. Nwiloh

2011-11-01

Full Text Available Although catamenial hemothorax compared to pneumothorax is a rarer clinical presentation of thoracic endometriosis syndrome (TES, it is more commonly associated with diaphragmatic fenestrations. These openings may serve as entry portals for peritoneal fluid to access into the pleural space thereby perpetuating recurrent pleural effusion even after prior surgical pleurodesis. We report our experience with two patients with recurrent right catamenial hemothorax after previous interventions that were subsequently treated by talc pleurodesis and goretex diaphragmatic patch, and who have had no further recurrence at a mean follow up of 15 months.We therefore recommend that diaphragmatic patch should be considered as an adjunct to talc pleurodesis in patients with recurrent catamenial hemothorax when either multiple diaphragmatic fenestrations are seen at surgery or if there is concomitant bloody peritoneal fluid which could potentially lead to recurrence. The patch by sealing any occult pores and possible future fenestrations appear to decrease recurrent pleural effusion at an intermediate term follow up. Resumo: Embora o hemotórax catamenial comparado com o pneumotórax seja uma apresentação clínica mais rara de síndrome de endometriose torácica (TES, está mais associado a fenestrações diafragmáticas. Estas aberturas podem atuar como portais de entrada para o acesso ao fluido peritoneal na cavidade pleural, perpetuando assim o derrame pleural recorrente mesmo após uma pleurodese cirúrgica prévia. Registamos a nossa experiência em dois pacientes com hemotórax catamenial recorrente do lado direito após outras intervenções, que foram posteriormente tratados com pleurodese com talco e penso diafragmático em gore-tex, e que não apresentaram nenhuma outra recorrência durante um acompanhamento de 15 meses.Recomendamos, então, que o penso diafragmático seja considerado um auxiliar à pleurodese com talco em pacientes com hemot

Unusual Presentation of Maydl's Hernia

African Journals Online (AJOL)

Nikhil NBA, Natarajan K, Mohanty A, et al. An. Unusual Case of Maydl's Hernia. Int J Cur Res Rev. 2013;5(6):22-5. 11. Ganesaratnam M. Maydl's hernia: Report of a Series of Seven Cases and Review of Literature. Brit J Surg. 1985;72:737-8. 12. Weledji EP, Mokake M, Ngowe MN. A Rare. Presentation of Maydl's Hernia.

[Analysis of clinicopathologic and survival characteristics in patients with right-or left-sided colon cancer].

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Hu, Junjie; Zhou, Zhixiang; Liang, Jianwei; Zhou, Haitao; Wang, Zheng; Zhang, Xingmao; Zeng, Weigen

2015-07-28

This study aimed to clarify the clinical and histological parameters, and survival difference between right- and left-sided colon cancer. We retrospectively analyzed the medical records (2006.1-2009.12) of 1 088 consecutive colon cancer patients who received surgery at our hospital. Right- and left-sided colon cancers were compared regarding the clinical and histological parameters. The survival analysis was performed by the Kaplan-Meier method, and the log-rank test was used to determine the statistical significance of differences. Right-sided colon cancer was associated with older age, a more advanced state, and poorly differentiated and undifferentiated adenocarcinoma (25.2% vs 13.2%), mucinous adenocarcinoma (33.5% vs 17.3%) and vascular invasion (9.9% vs 3.9%) were more commonly seen in right-sided colon cancer compared with right-sided colon cancer, and all these differences were statistically significant. Median overall survival was right, 67 months; and left, 68 months. The five-years overall survival of right- and left-sided colon cancer was I/II stage, 91.4% vs 88.6% (P = 0.819); III stage, 66.1% vs 75.4% (P = 0.010); and IV stage, 27.8% vs 38.5% (P = 0.020) respectively. Right- and left-sided colon cancers are significantly different regarding clinical and histological parameters. Right-sided colon cancers in stage III and IV have a worse prognosis.

Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.

Science.gov (United States)

Rodriguez-Acevedo, Omar; Elstner, Kristen E; Jacombs, Anita S W; Read, John W; Martins, Rodrigo Tomazini; Arduini, Fernando; Wehrhahm, Michael; Craft, Colette; Cosman, Peter H; Dardano, Anthony N; Ibrahim, Nabeel

2018-02-01

Operative management of complex ventral hernia still remains a significant challenge for surgeons. Closure of large defects in the unprepared abdomen has serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. We report outcomes of 56 consecutive patients who had preoperative Botulinum toxin A (BTA) abdominal wall relaxation facilitating closure and repair. This was a prospective observational study of 56 patients who underwent ultrasound-guided BTA into the lateral abdominal oblique muscles prior to elective ventral hernia repair between November 2012 and January 2017. Serial non-contrast abdominal CT imaging was performed to evaluate changes in lateral oblique muscle length and thickness. All hernias were repaired laparoscopically, or laparoscopic-open-laparoscopic (LOL) using intraperitoneal onlay mesh. 56 patients received BTA injections at predetermined sites to the lateral oblique muscles, which were well tolerated. Mean patient age was 59.7 years, and mean BMI was 30.9 kg/m 2 (range 21.8-54.0). Maximum defect size was 24 × 27 cm. A subset of 18 patients underwent preoperative pneumoperitoneum as an adjunct procedure. A comparison of pre-BTA to post-BTA imaging demonstrated an increase in mean lateral abdominal wall length from 16.1 cm to 20.1 cm per side, a mean gain of 4.0 cm/side (range 1.0-11.7 cm/side) (p LOL primary closure was achieved in all cases, with no clinical evidence of raised intra-abdominal pressures. One patient presented with a new fascial defect 26 months post-operative. Preoperative BTA to the lateral abdominal wall muscles is a safe and effective technique for the preparation of patients prior to operative management of complex ventral hernias. BTA temporary flaccid paralysis relaxes, elongates and thins the chronically contracted abdominal musculature. This in turn reduces lateral traction forces facilitating laparoscopic repair and fascial closure of large

[Hernia surgery in urology: part 1: inguinal, femoral and umbilical hernias - fundamentals of clinical diagnostics and treatment].

Science.gov (United States)

Franz, T; Schwalenberg, T; Dietrich, A; Müller, J; Stolzenburg, J-U

2013-05-01

Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias.

Stitch in the side: causes, workup, and solutions.

Science.gov (United States)

Eichner, E Randy

2006-12-01

Side stitch is an acute, localized, sharp, transient pain that occurs during exercise, most often in runners or swimmers, but also in those participating in team sports, and less often in cyclists. The pain is vexing and performance-limiting, but fleeting and benign. Three theories compete to explain it: diaphragmatic ischemia, stress on peritoneal ligaments, and irritation of the parietal peritoneum. The differential diagnosis seems broad, but the classic side stitch is so unique in its features and setting that a reasonable working diagnosis can be made from a careful history and physical examination. Practical tips, although anecdotal, offer lasting solutions.

Internal hernia in late pregnancy after laparoscopic Roux-en-Y gastric bypass.

Science.gov (United States)

Gruetter, Florian; Kraljević, Marko; Nebiker, Christian A; Delko, Tarik

2014-12-23

A 27-year-old patient in late pregnancy presented to the department of obstetrics with crampy abdominal pain located in the right flank, 3 years after a laparoscopic Roux-en-Y gastric bypass. Clinical investigation showed tenderness on palpation in the upper abdomen without signs of peritonitis. The cardiotocogram and blood tests were normal. The ultrasound showed a hydronephrosis on the right side, and a pigtail catheter was inserted. The abdominal symptoms did not abate and the abdominal surgeon was consulted 36 hours after admission. Diagnostic laparoscopy was performed promptly because of high suspicion of internal hernia (IH). Laparoscopy showed IH at the mesojejunal intermesenteric defect with a herniated common channel and volvulus of the anastomosis. Conversion to open reduction and complete closure with non-absorbable interrupted sutures was performed. Small bowel resection was avoided. The patient was discharged 10 days after the operation and a healthy boy was born 4 weeks later. 2014 BMJ Publishing Group Ltd.

Isolated Crural Hematoma Mimicking Retroperitoneal Lymphadenopathy, A Unique Sign of Traumatic Diaphragmatic Rupture: A Case Report

Directory of Open Access Journals (Sweden)

Abhishek Jha

2014-09-01

Full Text Available Diaphragmatic injury following blunt thoracoabdominal trauma is rare and is usually associated with key radiological features like dependent viscera sign, collar sign, diaphragmatic thickening and defects. It may also be associated with secondary signs like intrathoracic herniation of abdominal viscera. Diaphragmatic crura, which are attached to the upper lumbar vertebra represent prominently thickened folds along the posterior diaphragm, are usually inconspicuous on routine Computed Tomography (CT scans. We present a case of a young patient who sustained a motor vehicle accident and developed difficulty in breathing. CT scan of the patient revealed bilateral crural hematomas, with splenic and renal lacerations and no other sign of diaphragmatic injury. The patient was operated and blunt diaphragmatic rupture was confirmed at surgery.

Electromyographic permutation entropy quantifies diaphragmatic denervation and reinnervation.

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Christopher Kramer

Full Text Available Spontaneous reinnervation after diaphragmatic paralysis due to trauma, surgery, tumors and spinal cord injuries is frequently observed. A possible explanation could be collateral reinnervation, since the diaphragm is commonly double-innervated by the (accessory phrenic nerve. Permutation entropy (PeEn, a complexity measure for time series, may reflect a functional state of neuromuscular transmission by quantifying the complexity of interactions across neural and muscular networks. In an established rat model, electromyographic signals of the diaphragm after phrenicotomy were analyzed using PeEn quantifying denervation and reinnervation. Thirty-three anesthetized rats were unilaterally phrenicotomized. After 1, 3, 9, 27 and 81 days, diaphragmatic electromyographic PeEn was analyzed in vivo from sternal, mid-costal and crural areas of both hemidiaphragms. After euthanasia of the animals, both hemidiaphragms were dissected for fiber type evaluation. The electromyographic incidence of an accessory phrenic nerve was 76%. At day 1 after phrenicotomy, PeEn (normalized values was significantly diminished in the sternal (median: 0.69; interquartile range: 0.66-0.75 and mid-costal area (0.68; 0.66-0.72 compared to the non-denervated side (0.84; 0.78-0.90 at threshold p<0.05. In the crural area, innervated by the accessory phrenic nerve, PeEn remained unchanged (0.79; 0.72-0.86. During reinnervation over 81 days, PeEn normalized in the mid-costal area (0.84; 0.77-0.86, whereas it remained reduced in the sternal area (0.77; 0.70-0.81. Fiber type grouping, a histological sign for reinnervation, was found in the mid-costal area in 20% after 27 days and in 80% after 81 days. Collateral reinnervation can restore diaphragm activity after phrenicotomy. Electromyographic PeEn represents a new, distinctive assessment characterizing intramuscular function following denervation and reinnervation.

Abdominal wall hernias

DEFF Research Database (Denmark)

Henriksen, Nadia A; Mortensen, Joachim H; Lorentzen, Lea

2016-01-01

) with a history of more than 3 hernia repairs and 86, age-matched men without hernias. Biomarkers for synthesis of collagen type IV (P4NP) and type V (P5CP) as well as breakdown (C4M and C5M) were measured in serum by validated, solid-phase, competitive assays. Collagen turnover was indicated by the ratio between...

Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

Science.gov (United States)

Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

2010-12-01

Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

Abdominal wall hernias: computed tomography findings

International Nuclear Information System (INIS)

D'Ippolito, Giuseppe; Rosas, George de Queiroz; Mota, Marcos Alexandre; Akisue, Sandra R. Tsukada; Galvao Filho, Mario de Melo.

2005-01-01

Abdominal hernias are a common clinical problem Clinical diagnosis of abdominal hernias can sometimes be challenging, particularly in obese patients or patients with previous abdominal surgery. CT scan of the abdomen allows visualization of hernias and their contents and the differentiation from other masses of the abdominal wall such as tumors, hematomas and abscesses. Moreover, CT may identify complications such as incarceration, bowel obstruction, volvulus and strangulation. This study illustrates the CT scan findings observed in different types of abdominal wall hernias. (author)

Detection of Left-Sided and Right-Sided Hearing Loss via Fractional Fourier Transform

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Shuihua Wang

2016-05-01

Full Text Available In order to detect hearing loss more efficiently and accurately, this study proposed a new method based on fractional Fourier transform (FRFT. Three-dimensional volumetric magnetic resonance images were obtained from 15 patients with left-sided hearing loss (LHL, 20 healthy controls (HC, and 14 patients with right-sided hearing loss (RHL. Twenty-five FRFT spectrums were reduced by principal component analysis with thresholds of 90%, 95%, and 98%, respectively. The classifier is the single-hidden-layer feed-forward neural network (SFN trained by the Levenberg–Marquardt algorithm. The results showed that the accuracies of all three classes are higher than 95%. In all, our method is promising and may raise interest from other researchers.

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma.

Science.gov (United States)

Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae

2015-01-01

We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.