Case Of Diaphragmatic Hernia Research Articles

Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high-resolution manometry studies.

High-resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders. Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance-pH testing off-therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and <3 cm); Type III, when ≥3 cm of separation was present. Demographic and clinical characteristics were collected at baseline, including Age, Gender, Alcohol-, Coffee- and Smoke-habits, GERD diagnosis and symptoms' duration. Two cohorts of patients, with and without HH, were retrospectively individuated, and their association with Ineffective Peristalsis, Hypercontractile Esophagus and Outflow Obstruction was analyzed with univariate and multivariate Logistic regressions using the statistical software R. 848 consecutive patients were enrolled, and 295 cases of HH (34.8%), subdivided into 199 (23.5%) Type II- and 96 (11.3%) Type III-EGJ patients, were identified. Ineffective peristalsis was diagnosed in 162 (19.1%) subjects, Hypercontractile esophagus in 32 (3.8%), and Outflow Obstruction in 91 (10.7%), while GERD was present in 375 (44.2%) patients. HH was significantly associated with Ineffective Peristalsis (p < 0.001) and GERD (p < 0.001). Furthermore, HH resulted to be a risk factor for Ineffective peristalsis (OR 2.0, 95% CI 1.4-2.8, p < 0.001) both when the analysis was conducted in all the 848 subjects, independently from GERD, and when it was carried out in patients without GERD (OR 2.3, 95% CI 1.02-5.3, p = 0.04). The risk for Ineffective Peristalsis increased 1.3 times for every centimeter of HH. No statistically significant association was found between HH and Outflow obstruction or Hypercontractile Esophagus. An increasing separation between the LES and CD may lead to a gradual and significant elevation in the risk of Ineffective Peristalsis. Interestingly, this association with HH is true in patients with and in those without GERD, suggesting that the anatomical alteration seems to play a major role in motility change.

Laparoscopic proximal sleeve gastrectomy as an alternative for management of giant hiatal hernias

Background and aim: Large anatomic defects of the diaphragmatic hiatus known as giant hiatal hernias could be associated with reflux esophagitis disease (GERD) and other life-threatening complications such as gastric volvulus, ischemia and perforation, thus surgical repair is warranted. Although usually the key steps to surgical repair are reduction of the herniated stomach, complete excision of the sac, hiatus repair, and an antireflux procedure, surgery in these cases is associated with a great rate of anatomic and functional failure, therefore different techniques have been described since the original description of Collis gastroplasty designed to lengthen the short esophagus. Methods: We report here the technique and results performing proximal vertical gastrectomy or proximal sleeve gastrectomy (PSG) as an alternative in cases in which the possibility of recurrence of the hiatal hernia (HH) is high. Results: After years of follow-up after surgery, all the case patients presented here are free of gastroesophageal reflux or dysphagia symptoms, with no necessity for acid suppression medication, and no side effects of the surgery. Conclusion: The treatment of giant HH is a complex and challenging disorder to treat. PSG seems to be a good surgical alternative for the treatment of some special cases of giant HH minimizing the GERD symptoms and possible recurrences.

Diagnosis and treatment of severe diaphragmatic hernia in a cat: A case study

Hernia refers to the condition where visceral organs protrude through weak points or fissures in the diaphragm into the thoracic cavity or other anatomical cavities. Diaphragmatic hernia in cats is a pathological state where one or more visceral organs from the abdominal cavity enter the thoracic cavity through a ruptured diaphragmatic opening. It is predominantly caused by accidental trauma to the diaphragm or congenital diaphragmatic developmental anomalies. Timely treatment of diaphragmatic hernia in cats is crucial to prevent respiratory distress and potential life-threatening consequences. This article presents a case study of a severely affected cat with diaphragmatic hernia, its diagnosis through clinical and laboratory examinations, successful surgical treatment, and postoperative care, providing valuable insights for the management of similar feline diaphragmatic hernia cases.

Laparoscopic treatment of adult diaphragmatic hernia after minimally invasive hepatectomy: A case report and literature review

Introduction: History of surgery is the second most common cause of acquired diaphragmatic hernia (DH) after trauma. Herein, we present a case of diaphragmatic hernia following minimally invasive laparoscopic liver surgery. We also reviewed the literature on adult DH after hepatectomy, the primary surgical cause. Methods: Clinical case presentation and systematic literature review of adult DH after hepatectomy. Results: A 71-year-old male patient was diagnosed a DH 42 months after a right extended laparoscopic hepatectomy for alveolar echinococcosis. A minimal invasive approach permitted a primary suture with intraperitoneal onlay mesh. There is no sign of recurrence at the 19-months follow-up.

Laparoscopic diaphragm repair with bioabsorbable mesh in congenital and acquired diaphragmatic hernia

Background and Aim: Congenital or acquired diaphragmatic hernias are both possible. The present study aimed to investigate the superiority of laparoscopic surgery over open repair of congenital diaphragmatic hernias with bioabsorbable mesh in congenital and acquired diaphragmatic hernia. Patients and Methods: This retrospective study was conducted on 7 diaphragmatic hernia cases in the General Surgery Unit of Federal Government Polyclinic Hospital, Islamabad from January 2015 to December 2022. Diaphragmatic hernia was diagnosed and confirmed on CT scan. Patients with Bochdalek hernia (BH), right-sided eventration of diaphragm, and left eventration of diaphragm (ED) cases were enrolled. Individual demographic details, clinical manifestations, hernia description, treatment modalities, and complications were recorded. Results: The overall mean age was 42 years with an age range 30-62 years. Of the total cases, there were 6 (85.7%) male and 1 (14.3%) female. The incidence of Bochdalek hernia (BH), left-sided ED, and right-sided ED was 2 (28.6%), 4 (57.1%), and 1 (14.3%) respectively. The major defect on left and right side was 15× 7 cm and 15× 8 cm respectively.

Surgical Etiology of Respiratory Distress in Infant and Short Term Outcome at Benghazi Children Hospital (2017-2018)

Background: Respiratory distress (RD) is a common problem in newborns immediately following birth. It is often seen during the transition from fetal to neonatal life. Aims: This study was conducted to demonstrate the surgical causes of respiratory distress in infants admitted to paediatric surgical department of Benghazi Children Hospital and to describe the short term outcome of the sample. Methodology: A retrospective observational descriptive cross section study was done to achieve the aims of this study. Results: A sample of (50) children admitted with respiratory distress due to congenital anomalies, the age range of the sample was from one day to one year, male were (70%) and females and (30%). Residency (20%) from Benghazi and (80%) from outside Benghazi. Normal delivery was reported in52% of the cases and (48%) C/S, (86%) were born at term and (14%) preterm. The mean weight of the cases was (3.38) (±1.91) kg with minimum of (2) kg and maximum (10) kg. TOF in (52%), diaphragmatic hernia in (40%) and lung emphysema in (8%). Clinical presentation of the cases was mainly with respiratory distress in (84%), while (16%) presented with frothy secretion, ultrasound scan was done to (88%) and was normal. Echocardiogram was normal, atrial septal defect in (16%), ventricular septal defect in (14%), patent ductus arteriosus in (8%). (80%) were operated. Death was recorded in half of the cases. Cases with TOF were in total (26) cases of them (17) died and (9) survived, diaphragmatic hernia cases were (20), of them (12) discharged and (8) died, all cases of congenital lobar emphysema discharged. This association was highly significant Fisher`s (exact=6.9 P=0.005). all preterm neonate died (seven cases) and those who were term were in total (43) of them (25) survived and (18) died, Fisher`s (exact=10.85 P=0.005). Cases who were presented with respiratory distress were in total (42) of them (18) died and (25) discharged, while cases who presented with frothy secretions ....

A Case of Hiatal Hernia after Surgery for Esophageal Cancer Presented with Colonoscopy

A Case of Hiatal Hernia after Surgery for Esophageal Cancer Presented with Colonoscopy

A Case of Hiatal Hernia and Petersen's Hernia Causing Strangulated Ileus after Laparoscopic Total Gastrectomy

A Case of Hiatal Hernia and Petersen's Hernia Causing Strangulated Ileus after Laparoscopic Total Gastrectomy

Diaphragmatic hernia after radiofrequency ablation of liver metastases: a case report and review of the literature.

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).

A new method of ventilation inhomogeneity assessment based on a simulation study using clinical data on congenital diaphragmatic hernia cases

Congenital Diaphragmatic Hernia (CDH) is a diaphragm defect associated with lung hypoplasia and ventilation inhomogeneity (VI). The affected neonates are usually born with respiratory failure and require mechanical ventilation after birth. However, significant interindividual VI differences make ventilation difficult. So far, there are no clinical methods of VI assessment that could be applied to optimize ventilation at the bedside. A new VI index is a ratio of time constants T1/T2 of gas flows in both lungs. Pressure-controlled ventilation simulations were conducted using an infant hybrid (numerical-physical) respiratory simulator connected to a ventilator. The parameters of the respiratory system model and ventilator settings were based on retrospective clinical data taken from three neonates (2, 2.6, 3.6 kg) treated in the Paediatric Teaching Clinical Hospital of the Medical University of Warsaw. We searched for relationships between respiratory system impedance (Z) and ventilation parameters: work of breathing (WOB), peak inspiratory pressure (PIP), and mean airway pressure (MAP). The study showed the increased VI described by the T1/T2 index value highly correlated with elevated Z, WOB, PIP and MAP (0.8–0.9, the Spearman correlation coefficients were significant at P < 0.001). It indicates that the T1/T2 index may help to improve the ventilation therapy of CDH neonates.

Biallelic variants in PIGN cause Fryns syndrome, multiple congenital anomalies-hypotonia-seizures syndrome, and neurologic phenotypes: A genotype–phenotype correlation study

PurposeBiallelic PIGN variants have been described in Fryns syndrome, multiple congenital anomalies-hypotonia-seizure syndrome (MCAHS), and neurologic phenotypes. The full spectrum of clinical manifestations in relation to the genotypes is yet to be reported. MethodsGenotype and phenotype data were collated and analyzed for 61 biallelic PIGN cases: 21 new and 40 previously published cases. Functional analysis was performed for 2 recurrent variants (c.2679C>G p.Ser893Arg and c.932T>G p.Leu311Trp). ResultsBiallelic-truncating variants were detected in 16 patients—10 with Fryns syndrome, 1 with MCAHS1, 2 with Fryns syndrome/MCAHS1, and 3 with neurologic phenotype. There was an increased risk of prenatal or neonatal death within this group (6 deaths were in utero or within 2 months of life; 6 pregnancies were terminated). Incidence of polyhydramnios, congenital anomalies (eg, diaphragmatic hernia), and dysmorphism was significantly increased.Biallelic missense or mixed genotype were reported in the remaining 45 cases—32 showed a neurologic phenotype and 12 had MCAHS1. No cases of diaphragmatic hernia or abdominal wall defects were seen in this group except patient 1 in which we found the missense variant p.Ser893Arg to result in functionally null alleles, suggesting the possibility of an undescribed functionally important region in the final exon.For all genotypes, there was complete penetrance for developmental delay and near-complete penetrance for seizures and hypotonia in patients surviving the neonatal period. ConclusionWe have expanded the described spectrum of phenotypes and natural history associated with biallelic PIGN variants. Our study shows that biallelic-truncating variants usually result in the more severe Fryns syndrome phenotype, but neurologic problems, such as developmental delay, seizures, and hypotonia, present across all genotypes. Functional analysis should be considered when the genotypes do not correlate with the predicted phenotype because there may be other functionally important regions in PIGN that are yet to be discovered.

S3140 Posterior Mediastinal Mass: Unraveling a Non-Traumatic Herniation of the Caudate Lobe of the Liver

Introduction: Posterior mediastinal mass is most likely due to neurogenic tumor, meningocele or thoracic spine lesions. Caudate lobe of the liver herniation presenting as posterior mediastinal mass is a rare occurrence. Diaphragmatic herniation (DH) of the caudate lobe presents in various way including dyspnea, dyspepsia or incidental finding on imaging. We present a case of diaphragmatic hernia of the caudate lobe of the liver presenting as a posterior mediastinal mass found during evaluation of dyspnea. Case Description/Methods: A 75-year-old female presented to her physician with worsening shortness of breath from her baseline of 3 days duration. She had a history of sarcoidosis, COVID pneumonia over 1 year ago, COPD, diastolic heart failure, and hypertension. She was initially evaluated for COVID re-infection, which was negative and a CT of the chest with contrast to check for sarcoidosis flare revealed posterior mediastinal mass measuring 4.5 × 6.5 × 6.4 cm. Further work up with CT chest and abdomen with contrast revealed that the posterior mediastinal mass had similar attenuation as the liver and appears continuous with the caudate lobe of the liver. This was confirmed by NM scan of liver. Review of her records from an outside organization revealed similar finding on imaging a few years ago. Patient denied any history of trauma and laboratory work up revealed normal liver functions. After pulmonologist evaluation she was started on 2 L home oxygen following six-minute walk test, and also CPAP following a positive sleep study. Pulmonary function tests were performed and inhalers were continued. Given the chronicity of her symptoms and co-morbidities with stable caudate lobe herniation, conservative management was advised with surgery warranted if symptoms persist despite treatment (Figure 1). Discussion: DH is typically found on the left side with stomach or intestine while the right side is usually guarded by the liver. Isolated herniation of part of the liver into the thoracic cavity is rarely reported and is mostly acute from traumatic or spontaneous rupture requiring immediate repair. Our patient was initially evaluated for the posterior mediastinal mass for concerns of tumor, followed by the finding of what was thought to be acute herniation of the caudate lobe of liver into the thoracic cavity. Review of records showed this to be a stable lesion, we suspect that the patient had congenital diaphragmatic defect. Chronic and stable liver herniation into thoracic cavity can be managed conservatively if uncomplicated.Figure 1.: (A) Computed Tomography of chest with contrast (axial view) showing a well-defined soft tissue density lesion in the posterior mediastinum (red arrow). (B) Computed Tomography of the chest, abdomen and pelvis with contrast (sagittal view) showing well defined soft tissue mass in the posterior mediastinum (red arrow) similar in attenuation to the adjacent liver and appears continuous with the caudate lobe of liver.

323. CLINICAL CHARACTERISTICS OF HIATAL HERNIA WITH ANEMIA AND SIGNIFICANCE OF SURGICAL REPAIR

Abstract Most patients with hiatal hernia (HH) are asymptomatic. However, HH may provoke severe gastroesophageal reflex, anorexia, and anemia. Therefore, therapeutic indication and approach are controversial especially for elderly and frail patients. So, we investigated clinical features of HH with anemia and treatment outcome of surgical repair. From Jan. 2010 to Sep. 2021, 97 patients diagnosed HH by upper gastrointestinal scope and/or computed tomography and were taken blood test at the same time. Patients with malignant disease and after gastrectomy were excluded in this research. We examined the correlation between anemia and clinical characteristics (symptoms, physical and morphological factors) retrospectively. Similarly, hemoglobin(HGB) status after surgical repair were investigated. HGB of 21 cases (21.6%) represented less than 10 g/dl at the time of diagnosis. Elderly (p = 0.0007), disorders of the spine (kyphosis and scoliosis) (p = 0.006), typeIV hiatal hernia (p = 0.02), GERD (Grade ≥ A) (p = 0.07) were correlated with anemic cases of HH, which were consistent with clinical characteristic of giant hiatal hernia (GHH). In GHH (47 cases) with more than 30% stomach bulges into mediastinum, HGB of 17 cases (36%) represented less than 8 g/dl, and 9 cases (19%) were required blood transfusion. Six cases (13%) of GHH underwent surgical repair, and no exacerbation of anemia was observed after surgery. Elderly, kyphosis/scoliosis, and GHH were represented as the features of HH with anemia. Severe anemia is common symptom in GHH cases, and surgical repair might improve anemia in operable cases.

Dilated sigmoid colon with Chilaiditi's sign mimicking diaphragmatic hernia: A case report.

IntroductionChilaiditi's sign is a rare radiological presentation characterized by colonic interposition between the diaphragm and liver which is usually confused with conditions such as diaphragmatic hernia, pneumoperitoneum and subdiaphragmatic abscess.Case presentationWe report a case of 55 year old male presenting with abdominal pain since a year which was associated with abdominal fullness, loss of appetite and constipation. Further investigations showed us as a case of diaphragmatic hernia but intra operatively it was found to be Dilated sigmoid colon with Chilaiditi's sign.Clinical discussionIt is a rare incidental finding with major preponderance in male. The intestinal, hepatic and diaphragmatic causes predispose its pathology. Conservative management is the first line of treatment but the complicated abdominal pathologies are managed by various surgical intervention.ConclusionDilated sigmoid colon along with Chilaiditi's sign can sometime mimic as Diaphragmatic hernia which can make enormous difference in our pre and post-operative diagnosis. Chilaiditi's syndrome is a rare entity so early diagnosis is of utmost benefit.

Clinico-haematobiochemical Evaluation of Diaphragmatic Hernia and its Surgical Management in Cattle and Buffaloes- A Retrospective Study of 32 Cases

Background: Diaphragmatic hernia is an emerging threat in dairy animals due to accidental ingestion of potential foreign body via feed or fodder leads to traumatic reticulo pericarditis and net results into loss of milk production. Loss of milk production due to diaphragmatic hernia in dairy animals is worrying situation among the milkman and it needs to be addressed in early stage. Considering the livelihood of poor to marginal farmers on dairy animals, the present study aimed to evaluate the clinico-haematological changes and surgical management of diaphragmatic hernia in cattle and buffalo. Methods: The present retrospective study was carried in thirty two clinical cases of diaphragmatic hernia in cattle (17) and buffaloes (15) presented to teaching veterinary clinical complex from the rural area irrespective breeds, age and no. of lactation of animals. Result: The incidence was higher in recently parturited followed by advanced pregnant animals aged between 3.5-14 years (7.109±0.406) with duration of illness ranged between 4-35 days (16.563±1.627). All animals showed recurrent tympany, suspended rumination, constipation, neutrophilia, alkaline ruminal pH, lymphopenia and increased level of muscle enzymes and non-responsive to medicinal therapy. Plain radiography of thoraco-abdominal region showed break in continuity of diaphragmatic line and herniation of reticulum into thoracic cavity. All animals were subjected to surgical correction of diaphragmatic hernia under isoflurane general anaesthesia. Out of 32, 27 animals were recovered uneventfully and remaining five animals were succumbed during surgical repair of hernia due to cardiovascular failure. The present study concludes that, diaphragmatic hernia is common wasting disorders in dairy animals characterized by scanty faeces, recurrent tympany, neutrophilia, increased level of muscle enzymes due to chronic inflammatory changes and it can be treated successfully with herniorrhaphy under isoflurane general anaesthesia.

A Case of Hiatal Hernia with Incarcerated Necrotic Transverse Colon

A Case of Hiatal Hernia with Incarcerated Necrotic Transverse Colon

Hernia diafragmática tras radiofrecuencia de metástasis hepática. Reporte de caso clínico y revisión de la literatura

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).

A case of diaphragmatic hernia complicated by diaphragmatic resection

A case of diaphragmatic hernia complicated by diaphragmatic resection

Tension Pneumothorax due to Colon Perforation in Delay Post Traumatic Diaphragmatic Hernia: Case Report

Diaphragmatic injuries were described first by Sennertus in 1541. Rupture of the diaphragm due to blunt trauma is a rare event that is usually not detected in the acute phase of trauma and may manifest itself late and with dangerous complications. The common side effects of this injury include displacement of the abdominal viscera into the thoracic cavity, which can cause respiratory problems due to limited lungs. Abdominal organs such as stomach, omentum, intestines, spleen, and liver are the most common to herniate in to the thoracic cavity .In late presentation, the key point is to identify the patient’s strong clinical suspicion and history. CT scan is the most common modality in diagnosis of diaphragmatic hernia. In this article, we introduce a unique case of diaphragmatic hernia after trauma due to falling from a height of 2 years ago, which showed itself with a tension pneumothorax in its management.

Congenital diaphragmatic hernia: a retrospective study regarding the clinical experience of Bihor County Genetics Center

Congenital diaphragmatic hernia is an abnormality of embryologic development characterized by the persistence of communication between the thoracic and abdominal cavities, followed by an extremely high death rate despite medical progress. In Bihor county, according to a retrospective analysis of patient records from the Regional Center of Genetics, 30 children were diagnosed with congenital diaphragmatic hernia over a span of 28 years, from 1990 to 2018, most being male (73.3%). Predominant were the complex congenital diaphragmatic cases, meaning the cases of diaphragmatic hernia associated with other congenital abnormalities, 67% (20 patients) presenting at least one other congenital malformation. 95% (19 cases) of patients with complex congenital diaphragmatic hernia presented pulmonary abnormalities, the most frequent being pulmonary hypoplasia; 35% (7 cases) presented cardiac abnormalities. The Apgar score at 5 minutes after birth was significantly lower for patients with the clinical form of complex congenital diaphragmatic hernia. The mortality for the patients presenting the complex form was 100%, and for the patients presenting the isolated form was 20%. Karyotype analysis was performed for 17 patients, and 23.53% of them (4 patients) presented chromosomal abnormalities.