Variants of stomach position in different types of congenital diaphragmatic hernia in the fetus

Abstract

Purpose – to present detailed description for typical variants of the stomach location in left-sided congenital diaphragmatic hernia in the fetus in relation to the main topographic landmarks of the chest and abdomen, and to determine the relationship between the position of the stomach and anatomical variants of pathology. Material and methods. Analysis of the data from 235 ultrasound examinations of 157 fetuses in patients with left-sided diaphragmatic hernia, which were referred in 2007-2020. Results. In 3 cases (1.91 %) identification of the stomach and its location was impossible. In the remaining 154 cases, the following typical variants of stomach position were identified: intra-abdominal (22.73 %), intra-thoracic medial (12.99 %) and medial oblique (4.55 %), mid-ventral (21.43%), transverse ( 16.23 %), mid-dorsal (5.19 %), retrocardiac (5.84 %), paravertebral (2.6 %), left paracostal (1.3 %), and left pseudoanatomical (7.14 %) . With the abdominal localization of the stomach there was a shift of its pyloric part down to the bladder in 74.3 %, and in 17.1 % of cases stomach position was changed for intra-thoracic. Liver herniation was registered in 14.3% of cases with intra-abdominal stomach position, in 87.5% of mid-dorsal, and in 100% of cases with central-ventral, transverse, retrocardiac, paravertebral and left paracostal position. The liver was not detected in the thorax in cases with medial stomach position, and its identification was complicated in cases with oblique medial position. Conclusions. Typical anatomical variants of the stomach and other herniated abdominal organs location in the thorax of fetuses with left-sided diaphragmatic hernia were determined. The proposed classification system of anatomical variants of left diaphragmatic hernia with an emphasis on the stomach position will allow to improve the accuracy of prenatal ultrasound diagnosis, as well as individual prediction of postnatal outcome. Key words: congenital diaphragmatic hernia, congenital malformations, liver herniation, stomach position.