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Congenital Diaphragmatic Hernia: Report of Three Cases  [PDF]
Selahattin Katar,Celal Devecio?lu,Hatice ?ztürkmen Akay
Dicle Medical Journal , 2007,
Abstract: Congenital diaphragmatic hernia is associated with a high degree of morbidity and mortality. It may be diagnosed antenatally by Ultrasonografi. Postnatal survival rate significantly increases by means of appropriate management. Three cases presented in this report were without a prenatal diagnosis. One of the cases has right side congenital diaphragmatic hernia while other two cases have left side ones. None of them could survive for postnatal 8 hours. In our report, we aimed to remind that survival of these cases may be increased if disease is detected prenatally and the labor is realized in centers where neonatologist, pediatric surgeon and required equipment are present.
Delayed Presentation of Right-Sided Congenital Diaphargmatic Hernia Case Report
H Mohammad
Jos Journal of Medicine , 2011,
Abstract: Congenital diaphragmatic hernia (CDH) commonly occurs on the left and the patients usually present during neonatal period with respiratory distress. Rarely, the condition may occur on the right and the presentation may be delayed. This is a report of a patient with a right sided CDH who presented at three months but the correct diagnosis was at six months.
Congenital Diaphragmatic Hernia: Review of Current Concept in Surgical Management  [PDF]
Emeka B. Kesieme,Chinenye N. Kesieme
ISRN Surgery , 2011, DOI: 10.5402/2011/974041
Abstract: Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure. 1. Introduction The estimated incidence of congenital diaphragmatic hernia is 1 in 2000–5000 live births [1]. The aetiology of congenital diaphragmatic hernia is unknown, however, 2% of cases have been noted to be familial and another 15% of patients have associated chromosomal abnormalities [2]. Pulmonary hypoplasia is an important defect in congenital diaphragmatic hernia [2], and the severity of this pathology is largely dependent on the degree of pulmonary hypoplasia, pulmonary hypertension, and associated malformations. There have been recent advances in the medical management and postnatal care, all targeting the primary pathophysiological mechanism, and in the surgical management with the introduction of fetal interventions, laparoscopic repair, and lung transplantation. The treatment focus has also changed from emergency surgery at birth or presentation to surgical closure of defect after stabilization of the patient. Despite all these advances in neonatal care and surgical management, congenital diaphragmatic hernia (CDH) remains a condition with a significantly high mortality rate [3]. We aim to update clinicians in the recent advances in the diagnosis and surgical management of patients who present with Bochdalek hernia and Morgagni hernia. 2. Methods A literature search on the subject was done from 1970 till date using manual library search and journal publications on Pubmed/Medline, Google scholar, and EMBASE. We used the following keywords: congenital diaphragmatic hernia, Bochdalek hernia, Morgagni hernia, retrosternal, and posterolateral hernia. Full texts of the materials, including those of relevant references were collected and studied. Information relating to the epidemiology, prenatal diagnosis and fetal interventions, postnatal diagnosis, investigations and surgical treatment (open, laparoscopic, and robotic) was
A rare cause of recurrent pneumonia: A delayed diagnosis of Bochdalek hernia
Sekmenli T et al.
Konuralp Tip Dergisi , 2010,
Abstract: The incidence of congenital diaphragmatic hernia is 1/5000 in live births and 1/2000 in stillbirths. Cases are usually term newborns. Most prominent symptom is respiratory distress. Other organ malformations may accompany. Mortality rate is about 40-50%. Here, we presented a girl 2.5 years-old admitted with recurrent pulmonary infections and treated with medications but diagnosis of congenital diaphragmatic hernia (Bochdalek hernia) was delayed.
Prenatal diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center
Ruano, Rodrigo;Bunduki, Victor;Silva, Marcos Marques;Yoshizaki, Carlos Tadashi;Tanuri, Uenis;Macksoud, Jo?o Gilberto;Zugaib, Marcelo;
Clinics , 2006, DOI: 10.1590/S1807-59322006000300003
Abstract: 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, s?o 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.
Difficult weaning in delayed onset diaphragmatic hernia  [cached]
Ahmed Syed,Nadeem Abu,Pal Jyotishka,Gupta Rahul
Journal of Emergencies, Trauma and Shock , 2009,
Abstract: 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.
Congenital Bochdalek’s Diaphragmatic Hernia  [PDF]
Baba Usman Ahmadu,Chinda John Yola,Kaleb Abalis Abew
Journal of Nepal Paediatric Society , 2012, DOI: 10.3126/jnps.v32i3.6968
Abstract: Diagnosis of a rare Bochdalek’s congenital diaphragmatic hernia may be challenging. Our patient presented with respiratory and gastrointestinal findings. Chest radiograph revealed the stomach in the left thorax. Diagnosis of recurrent bacterial pneumonia was incorrectly made because of repeated symptoms. Chest radiograph can provide sufficient information for rapid diagnosis. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6968 J. Nepal Paediatr. SocVol.32(3) 2012 254-256
Bilateral Congenital Diaphragmatic Hernia  [cached]
Anjan K Dhua,Satish K Aggarwal,NB Mathur,GR Sethi
APSP Journal of Case Reports , 2012,
Abstract: Bilateral congenital diaphragmatic hernia (CDH) is a rare birth defect, with a poor prognosis. We describe a case of bilateral CDH discovered while repairing the right sided CDH. Diaphragmatic defect was repaired and a silo was applied on the abdominal wound to avoid abdominal compartment syndrome. The patient however died postoperatively due to severe pulmonary hypertension.
Congenital Diaphragmatic Hernia
Juan A Tovar
Orphanet Journal of Rare Diseases , 2012, DOI: 10.1186/1750-1172-7-1
Abstract: Congenital Diaphragmatic Hernia (CDH), ORPHA2140, OMIM 142340, 610187, 306950 and 222400CDH consists of a posterolateral defect of the diaphragm, generally located on the left side, that allows passage of the abdominal viscera into the thorax. The mediastinum is displaced to the contralateral side, the lungs are hypoplastic (Figure 1) and their arterioles are abnormal causing pulmonary hypertension. Respiratory and cardiovascular functions are severely compromised at birth and this, together with the frequently associated malformations, cause considerable mortality and morbidity. CDH was described many years ago [1,2] but survival after repair was not achieved until the 20th century. Pioneers of pediatric surgery [3] reported amazingly low mortalities until the actual severity of the condition surfaced when abortions, stillbirths and pre-hospital deaths were considered, adding a "hidden mortality" to operative and postoperative demises [4]. The pathophysiology of lung insufficiency and persistent pulmonary hypertension that threaten survival are currently better understood, but the results remain disappointing since mortalities near 50% are still reported when all deaths are taken into account in population-based series [5]. CDH management indeed remains one of the major challenges of perinatal medicine and surgery and active research on its mechanisms is warranted.CDH is a rare condition that occurs in < 1-5:10000 births [6]. It seems to be slightly more frequent in males and less frequent in blacks [7,8].CDH can be detected during fetal life when screening ultrasonography demonstrates herniation of the intestine and/or the liver into the thorax. Polyhydramnios may lead to antenatal diagnosis in some severe cases [9].Neonatal symptoms of CDH are heralded by respiratory distress with insufficient oxygenation, excavated abdomen with sternal protrusion and displacement of the heart sounds to the contralateral side. In severe cases, APGAR scores at 1 and 5 minutes are
Congenital diaphragmatic Bochdaleck hernia: case report  [cached]
Lava Jamile,Hettwer Guilherme A,Reginatto Cleiton,Galoro Guilherme
International Archives of Medicine , 2012, DOI: 10.1186/1755-7682-5-30
Abstract: Congenital diaphragmatic Bochdaleck hernia is an anatomical defect of the diaphragm, which allows protrusion of abdominal viscera into the chest, causing serious pulmonary and cardiac complications in the neonate. In this study we aimed to present a case of congenital Bochdaleck hernia. We investigated a 40 weeks old child, with a pregnancy carried out in a public hospital in Passo Fundo, Rio Grande do Sul, Brazil. We suggest that if diagnosis occurs in the prenatal period, the prognosis of this disease improves. As a consequence, it allows the parity of the fetus to occur in a higher complexity center, optimizing the chances of survival.
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