Presence Of Diaphragmatic Hernia Research Articles

HÉRNIA DIAFRAGMÁTICA CONGÊNITA DE APRESENTAÇÃO TARDIA: RELATO DE CASO

Congenital diaphragmatic hernia (CDH) is characterized by a closure defect in the diaphragm. Many patients’ present signs and symptoms at birth, but late manifestation may occur, making a difficult diagnosis due to a variable clinical condition. Surgery is necessary and the prognosis in the late presentation is favorable when compared to the early manifestation. We will report a case of a male infant, 7 months and 24 days old, with a history of recurrent dyspnea for 15 days, crying a lot, groaning and constipated. After chest radiography and confirmed by chest tomography, the presence of diaphragmatic hernia was confirmed. The surgery was performed and the patient was released after 7 days of hospitalization. In the face of an unusual late diagnosis, it is expected that such information corroborates the importance of the early diagnosis of CDH.

CT Findings of the Esophagus in Patients With Excessive Central Airway Collapse and Gastroesophageal Reflux

SESSION TITLE: Medical Imaging: New Approaches to Old Technologies SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Gastroesophageal reflux (GER) is increasingly recognized as an exacerbating or causal factor in patients with excessive central airway collapse (ECAC). Esophageal air of ≥10 mm and thickened esophageal wall (≥5 mm) on computed tomography of the chest might suggest esophageal pathology such as GER.1,2 The aim of this study was to evaluate the frequency of these and other CT findings of the esophagus in patients with GER and ECAC. METHODS: This was a retrospective review of patients with confirmed positive GER testing (acid and nonacid reflux) and ECAC on dynamic CT chest. We measured the largest internal lumen diameter and thickness of the esophagus at the level of the cricoid, sternal notch, and carina and in between the ventricles and distal esophageal sphincter at end inspiration on dynamic chest CT. We also recorded presence of GER-specific symptoms, presence of diaphragmatic hernia, signs of aspiration, and bronchial changes. RESULTS: Twenty-nine patients (median age 58[IQR 45-65]), 21(72%) women were included. Median BMI was 34 (IQR 29-39). Twenty-one patients (79%) have tracheobronchomalacia and 7 patients (21%) have excessive dynamic airway collapse. Frequent comorbidities included obesity in 72% (n=21), asthma in 48% (n=14), obstructive sleep apnea in 31 % (n=9) and cystic fibrosis in 3% (n=1). Seventeen of the 29 patients (58%) did not have clinical symptoms of GER. The median DeMeester score was 29.5 (IQR 23.9-45.9); impedance (non-acid reflux) was abnormal in 9 patients. The median of the maximal air-containing esophageal lumen and wall thickness were 9 mm (IQR 5.5-13) and 4mm (IQR 3-5) respectively. 12 patients (41%) had esophageal lumen of ≥ 10mm, 11 patients (38%) had wall thickness of ≥ 5mm, eight patients (27%) had sign of possible aspiration and 12 patients (41%) had hiatal hernia. Twenty of the 29 patients (69%) had at least one of the previous abnormalities. Nine patients (31%) had a complete normal esophagus on CT scan. CONCLUSIONS: Abnormal esophageal findings on CT have low sensitivity for GER. In patients with ECAC, normal esophagus on chest CT scan or absence of symptoms should not rule out GER. CLINICAL IMPLICATIONS: In ECAC patients, the decision to pursue a formal GER evaluation should not be based on the presence of typical GER symptoms (heartburn or reflux sensation) or esophageal abnormalities on chest CT scan.

Pentalogy of Cantrell in twins: A case report

INTRODUCTION. Pentalogy of Cantrell is a very rare congenital multiple malformation with the poor outcome. Syndrome included the following pentad: abdominal wall defect, a defect of the lower sternum, anterior diaphragm defect, ectopia cordis, as well as a variety of intracardiac anomalies. In the fifteenth week of the twin pregnancy, ultrasound examination showed multiple anomalies in one, as well as the absence of the nose apex in the other twin. The autopsy of the fetuses was performed after the abortion had been approved by the Ethics Committee. The external examination of the fetus number one showed ectopic heart and omphalocele. The internal examination revealed the existence of sternum cleft, ectopic heart and part of the left lung outside the thoracic cavity, the presence of diaphragmatic hernia with protrusion of abdominal organs, heart with only one large vessel and the horseshoe kidney. The full expression of the Pentalogy of Cantrell was confirmed. The external and internal examination of the other twin showed just agenesis of the nose apex. Recognition and diagnosis of the syndrome is of the exceptional importance. Proper and timely diagnosis should contribute to good outcome of the pregnancy and delivery.

Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line

Barrett's esophagus is a well-known complication of gastroesophageal reflux disease (GERD) and is associated with dysplasia and esophageal adenocarcinoma. Data on the prevalence of specialized intestinal metaplasia (SIM) in biopsy taken from an incidental irregular Z line are scarce. To determine the prevalence of SIM in biopsies taken from an incidental irregular Z line in consecutive patients undergoing upper endoscopy. During the study period, we identified all adult patients who underwent an upper endoscopy with biopsies from an incidental finding of an irregular Z line. Demographic characteristics, prevalence of endoscopic findings, and major complaints were compared between those with SIM and those without. A total of 166 out of 2000 (8.3%) consecutive patients were identified. Specialized intestinal metaplasia was found in 43.5% of all cases. Male sex and the presence of hiatus hernia were predictors of SIM (P=0.043 and 0.001, respectively), with relative risks of 2.02 (95% confidence interval: 1.01-4.0) and 3.31 (95% confidence interval: 1.66-6.58), respectively. In this endoscopic and histological study, SIM was found to be a common finding in patients with irregular Z line. Male sex and the presence of diaphragmatic hernia were significantly associated with the presence of SIM.

The treatment of perforated duodenal ulcer in the presence of diaphragmatic hernia.

The treatment of perforated duodenal ulcer in the presence of diaphragmatic hernia.

Surgical management of esophageal motility disturbances

During the past few decades, knowledge regarding normal and abnormal esophageal behavior has greatly increased because of the introduction of sophisticated techniques of studying esophageal function. As a result, the normal motility patterns of the esophagus are now well known, and conditions characterized by disturbances of esophageal motility can be readily recognized and therapy can be designed along more physiologic lines than heretofore. Motility disturbances of the esophagus can be classified as those involved with the upper esophageal sphincter and those involving the body of the esophagus and lower esophageal sphincter. Cricopharyngeal myotomy has played an increasing role in the management of abnormalities of function of the upper esophageal sphincter, particularly in patients with hypertension of the upper esophageal sphincter or incoordination of the upper esophageal sphincter as seen in pharyngoesophageal diverticulum. Esophagomyotomy has also found a useful place in the management of symptomatic patients with esophageal achalasia, in whom I believe it is the primary treatment of choice. Results of a properly performed myotomy suggest that an ancillary antireflux maneuver is not necessary. Although diffuse spasm of the esophagus and hypertensive sphincter represent different forms of esophageal motility disorders characterized by hypermotility rather than hypomotility, in properly selected patients a long esophagomyotomy has been useful in relieving the disabling symptoms of pain and dysphagia exhibited by most of these persons. Hypotension of the lower esophageal sphincter is now recognized as an underlying mechanism responsible for gastroesophageal reflux in a variety of disease states. Thus reflux and its debilitating sequence of ulcerative esophagitis and stricture formation should now be viewed as a physiologic abnormality rather than a strictly anatomic abnormality such as may occur in the presence of diaphragmatic hernia. Treatment is primarily medical and is designed to minimize the occasions of reflux and its effects by reducing gastric acids. Only in a small percentage of patients is surgical treatment in the form of an antireflux procedure required.