Left-sided Diaphragmatic Hernia Research Articles

An acute gastric volvulus in a child with congenital left diaphragmatic hernia: a case report

BackgroundAcute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported.Case presentationWe reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the “whirlpool sign” in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia.ConclusionIn this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a “whirlpool sign” in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.

Analysis of imaging in pediatric bronchopulmonary foregut malformations with literature review: case reports

BackgroundBronchopulmonary foregut malformation (BPFM) is an uncommon condition, with few case reports documented in both national and international literature. This scarcity underscores the importance of utilizing effective imaging techniques to improve our understanding and diagnostic precision concerning this disorder.Case descriptionIn the first case report, a neonate, born at full term and aged 15 days, presented with symptoms including dyspnea, coughing, wheezing, cyanosis, and vomiting. Initial diagnostic evaluations, which included chest radiography and upper gastrointestinal tract radiography, led to an erroneous initial diagnosis of a left-sided diaphragmatic hernia, accompanied by a suspicion of infection. In the second case report, another neonate, also born at full term but aged 5 days, exhibited symptoms such as coughing, choking, and mild vomiting. Utilizing a combination of computed tomography (CT) scans (plain, enhanced, and reconstructed), chest x-ray, and upper gastrointestinal tract radiography, the diagnosis of BPFM was accurately determined.ConclusionComprehensive imaging examinations play a crucial role in reducing misdiagnosis and diagnostic oversights in cases of BPFM. Given its rarity, BPFM often manifests as a sequestered lung accompanied by gastrointestinal abnormalities. Hence, the integration of CT scans with gastrointestinal tract radiography can substantially improve diagnostic precision in such cases.

Sustained inflation improves initial lung aeration in newborn rabbits with a diaphragmatic hernia.

Infants with a congenital diaphragmatic hernia (DH) have underdeveloped lungs and require mechanical ventilation after birth, but the optimal approach is unknown. We hypothesised that sustained inflation (SI) increases lung aeration in newborn kittens with a DH. In pregnant New Zealand white rabbits, a left-sided DH was induced in two fetal kittens per doe at 24-days gestation (term = 32 days); litter mates acted as controls. DH and control kittens were delivered by caesarean section at 30 days, intubated and mechanically ventilated (7-10 min) with either an SI followed by intermittent positive pressure ventilation (IPPV) or IPPV throughout. The rate and uniformity of lung aeration was measured using phase-contrast X-ray imaging. Lung weights in DH kittens were ~57% of controls. An SI increased the rate and uniformity of lung aeration in DH kittens, compared to IPPV, and increased dynamic lung compliance in both control and DH kittens. However, this effect of the SI was lost when ventilation changed to IPPV. While an SI improved the rate and uniformity of lung aeration in both DH and control kittens, greater consideration of the post-SI ventilation strategy is required to sustain this benefit. Compared to intermittent positive pressure ventilation (IPPV), an initial sustained inflation (SI) increased the rate and uniformity of lung aeration after birth. However, this initial benefit is rapidly lost following the switch to IPPV. The optimal approach for ventilating CDH infants at birth is unknown. While an SI improves lung aeration in immature lungs, its effect on the hypoplastic lung is unknown. This study has shown that an SI greatly improves lung aeration in the hypoplastic lung. This study will guide future studies examining whether an SI can improve lung aeration in infants with a CDH.

Late presentation Bochdalek hernia complicated by mesentero-axial volvulus

A 5 year old with a history of recurrent chest infections and presumed asthma presented to the emergency department with acute severe abdominal pain, tachycardia and pallor. Chest radiograph done to exclude pneumoperitoneum demonstrated a large gas filled structure occupying the majority of the left hemithorax. This was superimposed with several tubular gas filled structures. CT showed a large left-sided diaphragmatic hernia of the Bochdalek type containing the pancreas, stomach, small bowel loops, small bowel mesentery with vessels and lymph nodes and some large bowel. Associated left pulmonary hypoplasia was present. In addition, the stomach was significantly dilated with an ‘upside down’ configuration. It’s antrum and pylorus were above the diaphragm and gastro-oesophageal junction while its fundus and proximal body were below the diaphragm, appearances in keeping with mesentero-axial volvulus, necessitating urgent surgical management.

Diagnosis and management of thoracic endometriosis syndrome: Case report

Introduction: While the diagnosis of endometriosis is relatively common, thoracic endometriosis is a rare manifestation. Thoracic Endometriosis Syndrome (TES) most commonly presents with pneumothorax, 3% which are bilateral, making this case unique in the already limited breadth of TES with catamenial hemopneumothorax. Additionally, this patient had laboratory values constant with ovarian suppression yet continued menses and recurrent hemopneumothorax, necessitating surgical intervention. We propose that with this severity of disease a combination of surgical intervention and hormonal therapy is the ideal approach, providing the lowest rate of recurrence. Case description: A 33 year old woman with 2-day history of chest pain and shortness of breath with heavy menstrual cycles and significant dysmenorrhea. A chest radiograph and computed tomography scan revealed right-sided pneumothorax and bilateral hemothoraces with left-sided diaphragmatic hernia. Video-assisted thoracoscopic surgery confirmed sanguinous pleural effusions and biopsy proven endometriotic lesions. The patient was started on a gonadotropin-releasing hormone agonist and experienced short-interval recurrence of her symptoms. An aromatase inhibitor was added to her regimen and she underwent a left diaphragmatic hernia repair. Conclusions: The recurrence of symptoms despite complete hypothalamic-pituitary-ovarian axis suppression, in addition to the surgical requirements and findings make this case unique in the already limited breadth of thoracic endometriosis syndrome with catamenial hemopneumothorax.

Effect of prenatal diaphragmatic hernia on pulmonary arterial morphology.

Congenital diaphragmatic hernia (CDH) is a major cause of severe lung hypoplasia and pulmonary hypertension in the newborn. While the pulmonary hypertension is thought to result from abnormal vascular development and arterial vasoreactivity, the anatomical changes in vascular development are unclear. We have examined the 3D structure of the pulmonary arterial tree in rabbits with a surgically induced diaphragmatic hernia (DH). Fetal rabbits (n= 6) had a left-sided DH created at gestational day 23 (GD23), delivered at GD30, and briefly ventilated; sham-operated litter mates (n= 5) acted as controls. At postmortem the pulmonary arteries were filled with a radio-opaque resin before the lungs were scanned using computed tomography (CT). The 3D reconstructed images were analyzed based on vascular branching hierarchy using the software Avizo 2020.2. DH significantly reduced median number of arteries (2,579 (8440) versus 576 (442), p= .017), artery numbers per arterial generation, mean total arterial volume (43.5± 8.4 vs. 19.9± 3.1μl, p= .020) and mean total arterial cross-sectional area (82.5± 2.3 vs. 28.2± 6.2 mm2 , p=.036). Mean arterial radius was increased in DH kittens between the eighth and sixth branching generation and mean arterial length between the sixth and 28th branching generation. A DH in kittens resulted in threefold reduction in pulmonary arterial cross-sectional area, primarily due to reduced arterial branching. Thus, the reduction in arterial cross-sectional area could be a major contributor to pulmonary hypertension infants with CDH.

A successful management of left-sided posterior congenital diaphragmatic hernia of the jejunum, ileum, colon and left kidney: a case report

Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly in which abdominal contents herniate into the thoracic cavity due to underdevelopment of the diaphragm, possibly leading to pulmonary hypoplasia. Whereas surgery is not the first priority in treatment, it must be performed within a window of 2 weeks and after hemodynamic stability has been achieved. The patient described in this case report had a CDH of the jejunum, ileum, colon and left kidney diagnosed in a boy of South Asian origin who presented with tachypnea in the third hour of life. Imaging studies conducted included chest X-ray, chest ultrasound including echocardiogram, and abdominal and pelvic ultrasound. Treatment and management were successful despite complications. Future research on CDH is warranted in the populations in the Middle East, and local guidelines must be generated in order to improve diagnosis, treatment and prognosis.

Thoracoabdominal approach for traumatic diaphragmatic hernia in ahemodynamically unstable patient.

BackgroundDiaphragmatic hernias with strangulated contents are a surgical challenge. Thoracoabdominal incisions are commonly used for a variety of thoracic and vascular cases, although rarely used for diaphragmatic hernias, which are typically repaired with laparotomy, thoracotomy, or minimally invasive approaches.Case reportWe present the unique case of a 60-year-old, critically ill unstable patient with severe heart failure with a reduced ejection fraction (15–25%) and severe valve disease presenting with a left-sided diaphragmatic hernia containing strangulated small intestine and requiring urgent surgical exploration. This was safely and efficiently repaired via a thoracoabdominal approach at the index surgery, with intestines left in discontinuity and placement of temporary chest and abdominal closure. At the second planned operation, good continuity was successfully restored.ResultsThe patient had early extubation, gradual diet advancement with full recovery, and discharge home on postoperative day 17.ConclusionA thoracoabdominal incision can safely be used in large strangulated diaphragmatic hernias, including in critically unstable patients. This approach provides rapid access to both the chest and abdomen with excellent, speedy, and safe exposure, which can save a life in extreme conditions.

Infradiaphragmatic Total Anomalous Pulmonary Venous Return With Congenital Diaphragmatic Hernia: The Gut or the Heart—A Surgical Conundrum

Total anomalous pulmonary venous return (TAPVR) with diaphragmatic hernia (DH) is rare, with a mortality rate of up to 80%.1,2 In infradiaphragmatic (ID) TAPVR alone, there are previous reports of successful ductus venosus (DV) stenting to alleviate obstruction until definitive repair.3,4 We present the unconventional management of left-sided DH and ID-TAPVR. Three-dimensional (3D) vascular reconstruction and multidisciplinary collaboration led to a staged approach with transcatheter wire securement and eventual stent implantations in the DV and a horizontal segment between the umbilical vein (UV) and hepatic portal venous egress (HPVE), followed by surgical decompression of the bowel, and later successful cardiac repair with an excellent outcome.

Idiopathic left-sided diaphragmatic hernia: a rare clinical image.

Idiopathic diaphragmatic hernia, which occurs without a traumatic etiology, is a very unusual condition with a wide spectrum of medical symptoms. Cough, chest pain, dyspnea, upper abdomen pain, bowel bladder problems, and vomitus are some of the common respiratory and gastrointestinal symptoms. To minimize life-threatening morbidity and fatality, this is a case of idiopathic left-sided diaphragmatic hernia which is an extremely rare condition. A 60-year-old male with no history of trauma reported to have been experiencing pain in the left upper abdomen along- with breathing difficulties for the past 15 days. The pain was insidious in onset and progressive. On physical examination, chest expansion revealed differences of 2 cm, 2 cm, and 1 cm each along-with tenderness in the epigastric area. On auscultation, air entry was reduced bilaterally over lung fields. On investigation computed tomography (CT) impression of the abdomen and pelvis showed: 1) Large defect noted in left crus of the diaphragm with herniation of stomach to the left thoracic cavity.2) There is a shift of mediastinum towards the right side. 3) Herniation of abdominal contents into the thoracic cavity. 4) Mild left-sided-pleural effusion with the consolidation of the left basal lung.

Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation

Acquired diaphragmatic hernia (DH) following liver transplantation (LT) is usually considered a surgical emergency. Interplay of contributing elements determines its occurrence but, in children, LT with partial liver grafts seems to be the most important causative factor. This retrospective study describes the clinical scenario and outcomes of 11 patients with acquired DH following LDLT. During the study period, 1109 primary pediatric LDLT were performed (0.8% DH). The median age and BW of the recipients with DH at transplantation were 17months and 11.1kg, respectively; 63.7% of the cases had a weight/age Z-score of less than -2 at transplantation. The median interval between transplantation and diagnosis of DH was 114days (32-538days). A total of 6 (54.5%) of the patients had bowel obstruction due to bowel migration into the hemithorax. Ten defects were right-sided. Three patients required enterectomy and enterorrhaphy. Two patients required a new bilioenteric anastomosis, and one of them had complete necrosis of the Roux-in-Y limb. The patient with left-side DH presented gastroesophageal perforation. Most defects necessitate primary closure as the first treatment, and recurrence is rare. The associated problems encountered, especially related to intestinal complications, can determine increased morbidity following DH repair. Early diagnosis and intervention are required for achieving better outcomes.

Rare association of traumatic diaphragmatic hernia with spinal cord injury: A case report.

Introduction and importanceThe traumatic diaphragmatic hernia could be missed in the background of spinal fractures due to neurological weakness. We report the first case of the management of thoracolumbar fracture-dislocation associated with diaphragmatic injury.Presentation of case53-year-old male transferred from local hospital following fallen from a motorbike on the 4th day after the injury. He was paraplegic from L1 below with sacral root involvement. Further imaging showed fracture-dislocation of the vertebral body at the T12-L1 level and anterior displacement of T11 on T12. The left-sided diaphragmatic hernia was detected by chest x-ray with bowel shadows in the left hemithorax. Emergency laparotomy and diaphragmatic repair followed by a posterior spinal exploration and pedicle screw fixation were done. Early mobilization was done after spinal fixation and the patient is successfully continuing rehabilitation.Clinical discussionThoracolumbar fracture-dislocation associated with the traumatic diaphragmatic hernia is rare. Clinical diagnosis of associated visceral injuries could be delayed due to the neurological deficit of the patient. An initial concern was to repair the life-threatening diaphragmatic hernia. Even current studies showed improved neurological function from early spinal surgery, spinal fixation had to delay as surgery needs a prone position.ConclusionEarly identification and management of traumatic diaphragmatic hernia are life-saving and allows early surgical intervention for the spine. Early reduction and fixation are associated with improved neurological function and will allow early mobilization and reduce hospital and ICU stay.

Left-sided diaphragmatic hernia after a chest wound with a grenade. D-r S. Samuelson (D. medic. Woch. 1932, no. 9)

Dr. S. Samuelson (D. medic. Woch. 1932, no. 9) cites a case of left-sided diaphragmatic hernia after a chest wound with a grenade. For 16 years, diaphragmatic hernia was not recognized in b-th

Fetal Surgery for Congenital Diaphragmatic Hernia

Research Article| September 01 2021 Fetal Surgery for Congenital Diaphragmatic Hernia AAP Grand Rounds (2021) 46 (3): 33. https://doi.org/10.1542/gr.46-3-33 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Fetal Surgery for Congenital Diaphragmatic Hernia. AAP Grand Rounds September 2021; 46 (3): 33. https://doi.org/10.1542/gr.46-3-33 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fetal surgery, hernia, congenital diaphragmatic, fetal endoscopic tracheal occlusion Source: Deprest JA, Nicolaides KH, Benachi A, et al. Randomized trial of fetal surgery for severe left diaphragmatic hernia. N Engl J Med. 2021;385(2):107-118; doi: https://doi.org/10.1056/NEJMoa2027030Google Scholar Investigators from multiple international institutions conducted an open-label randomized controlled trial to assess the efficacy of fetal endoluminal tracheal obstruction (FETO) in fetuses with severe pulmonary hypoplasia secondary to left-sided diaphragmatic hernia. With FETO, a balloon is inserted into the trachea of an affected fetus prior to 30 weeks’ gestation and inflated; the balloon is deflated at a later point. The study was conducted at 10 FETO centers and 26 NICUs in multiple countries. Women >18 years old with a fetus with a left diaphragmatic hernia and severe pulmonary hypoplasia (fetal lung-to-head ratio <25% of predicted based on gestational age) who were <33 weeks, 6 days gestation... You do not currently have access to this content.

Right-sided strangulating diaphragmatic hernia in an adult without history of trauma: a\xa0case report

BackgroundDiaphragmatic hernia involves protrusion of abdominal contents into the thorax through a defect in the diaphragm. This defect can be caused either by developmental failure of the posterolateral foramina to fuse properly, or by traumatic injury of the diaphragm. Left-sided diaphragmatic hernias are more common (80–90%) because the right pleuroperitoneal canal closes earlier and the liver protects the right diaphragm. Diaphragmatic hernias in adults are relatively asymptomatic, but in some cases may lead to incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease. The aim of this report is to enlighten clinical doctors about this rare entity that can have fatal consequences for the patient.Case presentationWe present a rare case of a right-sided strangulating diaphragmatic hernia in an adult Caucasian patient without history of trauma. Clinical examination revealed bowel sounds in the right hemithorax, which were confirmed by the presence of loops of small intestine into the right part of the thorax through the right diaphragm, as was shown on chest X-ray and computerized tomography. Deterioration of the clinical status of the patient led to an operation, which revealed strangulated necrotic small bowel. Approximately 1 m of bowel was removed, and laterolateral anastomosis was performed. The patient had an uneventful postoperative recovery and was discharged 8 days later.ConclusionsSurgery is required to replace emerged organs into the abdomen and to repair diaphragmatic lesion. A delayed approach can have catastrophic complications for a patient.

Successful Surgical Repair of Left-Sided Diaphragmatic Hernia after Adult Orthotopic Liver Transplantation: Case Report

Postoperative delayed diaphragmatic hernia (DH) is a rare and uncommon event after adult orthotopic liver transplantation (OLT), which however could be potentially life-threatening complication, especially in the absence of early and correct diagnosis and appropriate surgical treatment. We present a case of 48 year-old male with left diaphragmatic herniation of left part of transverse colon, who thirty nine months before underwent OLT with right-sided allograft implantation and which was recently successfully managed by open abdominal approach in our institution. The postoperative course was uneventful and he was discharged at the 8th day after surgery. Our case illustrates, that delayed DH after the OLT in adults could be a new problem, which affect transplant recipients with long-term follow-up period. Hence, we consider, that once the diagnosis of DH is confirmed, the patient should be operated immediately, in order to avoid the possible life-threatening complications.

Anterior dynamic scoliosis correction in a patient with congenital left-sided false diaphragmatic Bohdalek hernia: one-stage surgical solution

A clinical case of treatment of lumbar scoliotic deformity combined with false congenital diaphragmatic hernia in a 17-year-old patient is presented. Stage surgical solution to the problem was achieved using dynamic scoliosis correction system installed through the anterior approach.

Fetal endoscopic tracheal occlusion and pulmonary hypertension in moderate congenital diaphragmatic hernia

Objective To study the role of fetal endoscopic tracheal occlusion (FETO) on resolution of pulmonary hypertension (PH) in fetuses with isolated moderate left-sided diaphragmatic hernia (CDH). Methods This retrospective study included fetuses with CDH evaluated between February 2004 and July 2017. Using the tracheal occlusion to accelerate lung growth (TOTAL) trial definition, we classified fetuses into moderate left CDH if O/E-LHR (observed/expected-lung head ratio) was 25–34.9% regardless of liver position or O/E-LHR of 35–44.9% if liver was in the chest. Postnatal echocardiograms were used to diagnose PH. Logistic regression analyses were performed to determine the relationship of FETO with study outcomes. Results Of 184 cases with no other major anomalies, 30 (16%) met criteria. There were nine FETO and 21 non-FETO cases. By hospital discharge, a higher proportion of infants in the FETO group had resolution of PH (87.5 (7/8) vs. 40% (8/20); p=.013). FETO was associated with adjusted odds ratio of 17.3 (95% CI: 1.75–171; p=.015) to resolve PH by hospital discharge. No significant differences were noted in need for ECMO or survival to discharge between groups. Conclusions Infants with moderate left-sided CDH according to O/E-LHR, FETO is associated with resolution of PH by the time of hospital discharge.

Розміри легень при різних анатомічних варіантах вродженої діафрагмальної грижі у плода

The objective: to compare lung indices in fetuses with different anatomical variants of left-sided congenital diaphragmatic hernia, determined by two-dimensional ultrasound examination. Materials and methods. Data from 157 ultrasound examinations in 136 fetuses as patients with the most typical anatomical variants of left-sided diaphragmatic hernia were analyzed. The area of the lungs and the herniated liver were measured in the standard cross section of fetal thorax, at the level of a four-chamber view, with following calculation of prognostic indices. Comparison of indices’ means in groups depending on the abdominal organs herniated into fetal chest was performed using Student’s t-test. Results. The most numerous group in our study was one with herniation of the liver, stomach and intestines (62.5%). Significantly lower values of all lung indices were found in this group (p≤0.0001). In particular, observed-to-expected area ratio equaled to 35.59±8.8 and 31.73±10.51 in these fetuses in II and III trimesters respectively. In fetuses with intestines herniation, this index was 60.67±10.93 and 57.37±7.98, in fetuses with stomach and intestines herniation – 53.20±7.02 and 51.77±9.57 in II and III trimesters, respectively. Differential analysis of lung indices depending on the degree of liver herniation showed the presence of statistically highly significant difference in both second and third trimesters. In the group with mild liver herniation, the largest lung sizes and indices were determined, which were similar to values registered in groups without hepatic herniation. The lowest values of all lung indices were registered in the group with severe liver herniation. Conclusions. The anatomical variant of left diaphragmatic hernia with herniation of liver, stomach and intestines into thorax was the most common among our study population; in this group the lowest values of term-independent lung indices were observed. However, this group turned out to be heterogeneous: with different degrees of liver herniation, different degrees of pulmonary hypoplasia were found. Significant differences in lung indices found in II trimester can become a basis for early assessment of the severity of pathology and prediction of postnatal outcome. Keywords: congenital diaphragmatic hernia, liver herniation, pulmonary hypoplasia, lung size, prenatal diagnosis.

Thoracoscopic repair of diaphragmatic hernia following ventricular assist device implantation

BackgroundDiaphragmatic hernia is a rare complication of ventricular assist device (VAD), mainly developing after explantation of the device. We herein report a case of diaphragmatic hernia that developed following the implantation of VAD.Case presentationA 4-month-old girl with a diagnosis of dilated cardiomyopathy underwent VAD implantation for a bridge to heart transplantation. Three months later, intermittent vomiting developed, and left-sided diaphragmatic hernia was confirmed on plain X-ray and computed tomography. Without any findings of ischemia, we performed elective thoracoscopic repair of the diaphragmatic hernia. In the right decubitus position, thoracoscopy revealed the small intestine to be herniated into the left thorax. After reduction of the herniated intestine, the defect of the diaphragm (3 × 2 cm in size) was directly closed with interrupted non-absorbable sutures. Her postoperative course was uneventful.ConclusionThoracoscopic repair of diaphragmatic hernia associated with VAD implantation may be a safe approach.