Left-sided Diaphragmatic Hernia Research Articles

Stomach position as an in utero predictor of neonatal outcome in left-sided diaphragmatic hernia

An 8-year review of neonates with left-sided congenital diaphragmatic hernia who presented in severe respiratory distress at birth was retrospectively reviewed looking at stomach position, thoracic or abdominal, as a predictor of survivability. Survival was 93% with the stomach below the diaphragm compared with 29% when the stomach was thoracic in location. Stomach position may be an important early in utero predictor of high mortality in neonates with left-sided congenital diaphragmatic hernias.

Chylothorax and chylous ascites following diaphragmatic hernia repair

Chylothorax following repair of a leftsided diaphragmatic hernia is uncommon; only five reports have appeared in the literature [1, 3, 6, 8, 12]. Chylous ascites has been reported once [11]. We report three cases of chylothorax with associated chylous ascites. All three were managed conservatively by external drainage and parenteral nutrition or medium-chain triglyceride feeds.

Congenital diaphragmatic hernia: the prognostic significance of the site of the stomach.

Congenital diaphragmatic hernia is associated with a significant mortality, despite intensive treatment. The degree of pulmonary vascular hypoplasia is the main factor affecting mortality. Various features have been considered to determine the prognosis in these infants. In this study a series of 50 consecutive cases of left-sided diaphragmatic hernia has been reviewed. The site of the stomach (abdominal or intrathoracic), demonstrated radiologically and confirmed at operation, has been related to the final outcome (survival or death). An abdominal site is associated with an excellent prognosis (6.2% mortality), while an intrathoracic site is associated with a 58.8% mortality.

Bilateral congenital posterolateral diaphragmatic hernia

The 11th recorded case of bilateral congenital posterolateral diaphragmatic hernia is here presented. Left-sided diaphragmatic hernia was corrected surgically, while the baby expired because of respiratory failure on the 31st operated day. Autopsy revealed that the baby had right posterolateral diaphragmatic defect with sac. From this experience, it might be said that at surgery for left-sided hernia, right diaphragm should be examined carefully.

Congenital diaphragmatic hernia in monozygotic twins

This is the third reported instance of identical twins, each with left-sided posterolateral congenital diaphragmatic hernia (CDH) (Bochdalek type), who have been operated upon successfully. The associated anomalies were mirror image undescended testicles. Comparative review of familial and sporadic cases of CDH revealed that males were more commonly affected in the former, while females were more commonly affected in the latter. There was no known etiology in either type. Both familial and sporadic cases shared a high incidence of associated anomalies (40% to 50%). Three anomalies were equally found in both types, mainly pulmonary hypoplasia, intestinal malrotation, and patent ductus arteriosus. Central nervous system anomalies were highly prevalent in the sporadic cases (55% to 75%), while cardiovascular and genitourinary anomalies (30% each) were the more common anomalies encountered in the familial cases.

Creation and repair of diaphragmatic hernia in the fetal lamb: Lung develpment and morphology

Left-sided diaphragmatic hernias were created in 26 lambs at about 78 days' gestation and repaired at 106 to 124 days' gestation. Nine of these lambs were delivered at term and lived much longer than the nonrepaired lambs delivered at term. The normal development of the fetal lamb lung is compared and contrasted with the development of the lung after creation of a diaphragmatic hernia and also with the changes in morphology resulting from in-utero repair. Creation of a diaphragmatic hernia resulted in marked delay in the development of alveoli and at term the lung had small, thick-walled terminal air-spaces with few capillaries and no true alveoli when compared with the thin-walled alveoli in normal lungs. Another striking feature was an apparent increase in the frequency of type II alveolar cells in diaphragmatic hernia lungs. In-utero repair of the diaphragmatic hernia resulted in a more normal appearance with true alveoli developing by term, although capillaries appeared to be less numerous and type II cells more numerous than in normal lungs. Surprisingly, there appears to be little difference between the left and right lungs in lambs with diaphragmatic hernia.

Morphologic analysis of the pulmonary vascular bed in congenital left-sided diaphragmatic hernia

The contribution of an abnormal pulmonary vascular bed to right-to-left shunting in patients with congenital left-sided diaphragmatic hernia and alveolar hypoplasia has not been defined. In three infants we analyzed lungs fixed by perfusion. Left lung volumes (ml/kg birth weight) were 1.7, 6.5 and 4.0 respectively (control = 11.7) and right lung volumes 5.7, 11.7 and 9.8 respectively (control = 14.3). Serial sections were prepared and fifth generation (resistance) vessels identified. Compared to control the medial widths were increased in all lungs and the medial width/external diameter ratios were increased in the left lungs of two patients and the right lung of one. The m/d ratio in the left lung was greater than that in the right lung in two of the three patients. There were fewer pulmonary vessels/cm2 lung tissue in the study lungs than in the control lung, and there were significantly fewer pulmonary vessels/cm2 lung tissue in the left than in the right lung in two of the three patients. Although there was increased smooth muscle in resistance vessels, intravenous therapy with tolazoline HCl did not improve systemic oxygenation. We conclude that this was probably due to the decreased total size of the pulmonary vascular bed and the decreased number of pulmonary vessels per unit lung tissue, causing a fixed high pulmonary vascular resistance.

Strangulating Diaphragmatic Hernia

Abstract Understanding that strangulated diaphragmatic hernia is a thoracoabdominal complex consisting of distinctive gastrointestinal and cardiorespiratory features will facilitate earlier diagnosis and treatment. Strangulated diaphragmatic hernia is a fatal condition unless promptly recognized and surgically treated. The abdominal manifestations of the acute complex include sudden excruciating upper abdominal pain and tenderness, nausea and vomiting, and gastrointestinal bleeding or shock or both. The thoracic portion of the complex is characterized by severe lower chest or substernal pain with radiation to the neck or shoulder. Dyspnea and cyanosis result from a mediastinal shift produced by massive distention from herniated viscera or pleural effusion or both. A gastrointestinal series should be obtained in all patients with crushed chest injuries, multiple rib or pelvic fractures, or severe blows to the lower thorax or upper abdomen before discharge from the hospital. The thoracic approach is preferred for left-sided strangulated diaphragmatic hernia, but the abdominal route may also be satisfactory. The thoracic approach is essential for proper management of strangulated hernia occurring on the right side.

Diaphragmatic hernia associated with pregnancy

<h2>Abstract</h2> Among 13 cases of diaphragmatic hernia found in parous women during the last fourteen years at the University Hospitals, 1 woman died during parturition from strangulation of viscera in a left-sided diaphragmatic hernia. This patient had had 3 previous uncomplicated deliveries.