Right-sided Diaphragmatic Hernia Research Articles

Right-Sided Bochdalek Hernia Associated with Group B Streptococcal Sepsis in a Preterm Neonate

ABSTRACT We report here a compelling case of a premature female newborn who was originally treated for breathing difficulties that arose a few hours after delivery. The initial chest radiograph showed no abnormalities, and the blood culture detected sepsis caused by group B streptococcus (GBS). The antibiotic treatment was modified accordingly. Later on, she experienced a gradually increasing opacification in the right side of her chest, which did not respond to medical treatment. A subsequent imaging examination conducted a few days later indicated the presence of a hernia in the right side of the diaphragm. The neonate, who was 14 days old, received surgical intervention to fix the abnormality in the diaphragm. The procedure was successful, and there were no complications during the postpartum period. This case report aims to emphasize the distinctive correlation between early-onset GBS sepsis and the postponed occurrence of right-side diaphragmatic hernia.

Iatrogenic Right-Sided Diaphragmatic Hernia After Colonoscopy

Iatrogenic Right-Sided Diaphragmatic Hernia After Colonoscopy

Delayed presentation of traumatic hepatothorax: An anesthetic and surgical perspective

: Traumatic diaphragmatic hernia is an uncommon sequela of blunt and penetrating trauma. It is estimated that 0.8–1.6% of patients with blunt trauma develop diaphragmatic rupture. However, the diagnosis of this condition is often overlooked, with right-sided hernias missed more frequently than left-sided hernias. Early diagnosis and repair are essential to prevent future complications such as strangulation and ischemia of intra-abdominal organs, lung collapse, and cardiovascular demise.: A 17-year-old male (180 cm; 86 kg) with no comorbidities presented to the emergency department (ED) following a high-velocity, unrestricted, rear-ended motor vehicle crash (MVC). The patient was intubated and hemodynamically stabilized in the ED, with planned surgical exploration of the abdomen. Six days following the accident, the patient was extubated; he became increasingly hypoxic and tachypneic over the next day. A CT of the chest and pelvis was ordered, confirming the diagnosis of a post-traumatic right-sided diaphragmatic hernia. An exploratory laparotomy was scheduled. Difficulties with ventilation were encountered due to suspected lung compression by the liver and movement of the endotracheal tube into the right main lung bronchus. : Traumatic diaphragmatic hernia should be considered in all patients presenting with abdominal trauma and should be suspected if respiratory distress arises during the patient’s clinical course. The recommended anesthetic approach is rapid sequence intubation with a cardiovascular-stable agent like etomidate and gastric decompression. Difficulties with intubation and ventilation should be anticipated due to the presence of the visceral organs within the thoracic cavity.

Thoracoscopic repair of right-sided congenital diaphragmatic hernia in the pediatric age: systematic review

Thoracoscopic repair of right-sided congenital diaphragmatic hernia in the pediatric age: systematic review

The silent threat: A retrospective study of right-sided traumatic diaphragmatic hernias in a university hospital.

In hospital attendance, 75% of diaphragmatic hernias occur on left as opposed to 25% on the right side. Right side hernias are associated with abdominal injuries, mainly the liver. However, right-side injuries are frequently underdiagnosed due to the complexity of associated injuries and high mortality rates. The aim of this study was to perform a retrospective analysis of records from our clinical experience to investigate demographics, TM, diagnosis, morbidity, and mortality associated with right sided TDH. These findings may provide insights into improving the clinical management of patients with this serious injury, potentially reducing morbidity and mortality rates. Retrospective analysis of the medical records of patients from the trauma database of the Division of Trauma Surgery at University of Campinas in 32-year period was performed. Only records of patients with right sided TDH were included in the analysis. Blunt trauma was the most common mechanism. Diagnoses were made by laparotomy in eight cases, all these cases were hemodynamically unstable. TDH grade III injury occurred in most cases followed by grade IV. Liver injuries were present in almost all cases, most of them high grade, followed by colon and small bowel. Extra-abdominal associated injuries with a predominance of femur fractures, pelvic fractures and hemothorax. Post-operative complications were associated with length of stay in intensive care unit. Pneumonia was the most frequent complication. The overall mortality rate was 16%. Most diagnoses were performed through laparotomy and not by radiologic exams, due to hemodynamic instability on admission. There is underdiagnosis of right-side TDH due to the high-energy trauma mechanism with high grade associated injuries and mortality on pre-hospital.

Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia.

To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH. Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV). MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781-1.000)), PH (0.828, 95%CI: (0.661-0.994)), and ECMO therapy (0.813, 95%CI: (0.645-0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR. We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH. Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH. • We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility. • Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance. • Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.

472 Right-sided diaphragmatic hernia causing gastric outlet obstruction 1 month after trauma

Abstract Diaphragmatic hernias arising from trauma are rare, and scarcely present in a delayed manner. This case report highlights a case of delayed presentation of a right-sided post-traumatic hernia in a 73-year-old woman following a fall. This report sheds light on the diagnostic peculiarities and management. The woman presented with a 3-day history of abdominal pain and coffee-ground vomiting. This followed a fall a month ago. Computed Tomography confirmed the diagnosis of a gastric outlet obstruction secondary to a right-sided diaphragmatic rupture. At surgery, the herniated abdominal contents were reduced, and the diaphragmatic defect fixed. The postoperative recovery was unremarkable and the patient discharged on day 4. This case highlights that diaphragmatic hernias should be considered as differential diagnoses following recent trauma.

Non-traumatic right-sided diaphragmatic hernia in a healthy adult male.

Non-traumatic right-sided diaphragmatic hernia in a healthy adult male.

Laparoscopic Repair of a Right-Sided Diaphragmatic Hernia: A Technical Report.

Introduction: Occult diaphragmatic hernias after trauma are relatively rare and may present months to years after the traumatic event. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal visceral organs. This study presents a case of a patient with a symptomatic diaphragmatic hernia secondary to a trauma >30 years prior. A literature review of this defect was performed examining the pathophysiology, presentation, and operative considerations. Case Presentation: A 58-year-old male with a history of multiple traumatic motor vehicle accidents 30 years prior presented with abdominal pain and obstructive symptoms. Axial imaging demonstrated a right-sided diaphragmatic hernia defect containing small intestine, colon, and omentum. He ultimately underwent a transabdominal laparoscopic repair of the defect with mesh buttressing. Postoperative the patient recovered well and was discharged without complications. Conclusion: Limited data outside of case reports exist for surgical management of occult diaphragmatic hernias secondary to trauma. Reported management options include open and minimally invasive thoracic as well as open and minimally invasive abdominal approaches; each with advantages and disadvantages. Depending on the defect size, both primary repair and repair with mesh reinforcement are appropriate options. More data comparing the approach and repair technique are needed to determine the best technique.

Laparoscopic Repair of a Right-Sided Diaphragmatic Hernia

Introduction: Blunt trauma may cause small occult diaphragmatic injuries that increase in size over the course of decades. The gradual increase is secondary to the pressure disparity between the abdominal and thoracic cavities. Over time, visceral contents may traverse the defect and become incarcerated within the thoracic cavity.1 Typically, the defect occurs on the left side with gastric herniation. Rarely, the defect occurs on the RIGHT side since the large right lobe of the liver may preclude herniation through a right-sided diaphragmatic defect.2,3 This video presents a repair of a symptomatic right-sided diaphragmatic hernia that occurred decades after blunt trauma. Materials and Methods: A 58-year-old man was admitted to the emergency department with a 2-day history of acute abdominal pain that was sharp and diffuse. He had vomited several times and denied flatus for 24 hours. He had a history of three prior motor vehicle accidents in the 1980s. He had a history of oropharyngeal cancer that was treated with radiation then a neck dissection 2 years before presentation. He had no history of abdominal or thoracic surgery but had a significant tobacco history for 40 years. His blood work was normal. A CT scan of the abdomen showed a right-sided diaphragmatic hernia defect that contained small intestine and colon. There was no dilated bowel or evidence of a pneumoperitoneum or free fluid. There was air in the rectum. A well-healed old nondisplaced pubic rami fracture was evident also on the scan. Surgical intervention included a laparoscopic possible thoracoscopic diaphragmatic repair. Operatively, he was placed in a semilateral position at 30°. A Veress needle was used to enter the abdomen and three 5 mm ports were placed along the subcostal border. One of the 5 mm ports was upsized to a 10 mm port. Diagnostic laparoscopy delineated the diaphragmatic defect containing bowel. Several adhesions were divided and the colon and small intestine were reduced from the defect. There was no hernia sac and the thoracic cavity was pristine. Once the bowel was reduced, the defect was measured at ~5 cm by 3 cm. The defect was closed with interrupted 0-silk sutures. The suture line was then buttressed with a 15 cm by 10 cm mesh. The mesh was secured with absorbable tacks. A 28F chest tube was placed. Results: The operative time was 90 minutes. The patient was started on a clear liquid diet on postoperative day 1 and advanced to a regular diet on postoperative day 2. Because of social issues, he was discharged on postoperative day 4. A chest CT at ~6 months postoperatively showed no evidence of a recurrent diaphragmatic defect. Conclusions: Minimally invasive techniques are well suited for diaphragmatic defects. If a right-sided symptomatic diaphragmatic hernia is diagnosed, a minimally invasive approach through the abdomen may be performed without a thoracic approach. Adhesions may warrant thoracic access to reduce the abdominal contents, so double lumen intubation is prudent. A durable repair may be obtained by suturing the defect and adding a mesh buttress. Patient consent has been obtained. Authors have received and archived patient consent for video recording/publication of the procedure. There are no conflict of interests associated with this video in terms of commercial or financial interests. Runtime of video: 5 mins 42 secs

The results of treatment of newborns with right-sided and left-sided intrathoracic localization of the liver with diaphragmatic hernia

BACKGROUND: The right-sided congenital diaphragmatic hernia is the rare pathology. Results of diagnostics, prognosis and treatment usally published as a collection of cases.&#x0D; AIM: Comparition of treatment results of congenital diaphragmatic hernia with the liver as its content in dependancy of the side.&#x0D; MATERIALS AND METHODS: We present a retrospective analysis of 50 newborn patients with congenital diaphragmatic hernia. Patiens were divided in two groups, first with right-sided (19 patients), and second with left-sided hernia (31 patients). Groups were compared by gender and weigth. Comparition criteria was the results of prenatal and postnatal diagnostics, intraoperative data, postoperative period, complications and outcomes.&#x0D; RESULTS: We found predominance of prenatal diagnosis in the second group (48% vs 84%, p = 0,001). The lung-to-head circumference ratio were the same in both groups (0,52 in first, 0,46 in second, p = 0,058). Chance to use thoracoscopic approach in the second group was higer in 5,7 times (48% vs 84%). Postoperative period was easier in the group of right-sided congenital diaphragmatic hernia: artificial ventilation lasted on average 8 days (min 3; max 28) versus 11 (min 4; max 50) days in the first group (p = 0,036).&#x0D; Hospital stay was significantly lower in the second group 18 days (min 12; max 28), versus 50 days in the first group (min 13; max 64), p = 0,011. Recovery chance in patients with right-sided hernia was higher (45% vs 79%, confidence interval 0,0590,814).&#x0D; CONCLUSIONS: Every type of diaphragmatic hernia, including right-sided location, need to be the subgect of research of high compitantive center. Prognostic criteria for right-sided congenital diaphragmatic hernia require furter advanced study, wich is possible only in case of concentration of patients in the same center.

Prenatal diagnosis of right-sided congenital diaphragmatic hernia

Prenatal diagnosis of right-sided congenital diaphragmatic hernia

Associated intraabdominal malformations of right-sided congenital diaphragmatic hernia: A rare anomaly and review

There is scarce literature on associated anomalies of right-sided congenital diaphragmatic hernias (CDH). The purpose of this study was to expand the presentation of a unique clinical experience by a literature review. Only six articles of a right-sided CDH linked to non-cardiac anomalies with complicated diagnostic and treatment scenarios were found related to ours. To the best of our knowledge, it is the first presented case of a right-sided CDH with multiple intestinal atresias and an intrathoracic right kidney. This case alerts physicians to take all examination details into account to avoid delaying CDH diagnosis. Most importantly, it gives valuable insight into possible associated anomalies of right-sided congenital diaphragmatic hernias and may benefit future embryological or genetic studies.

Right-sided congenital diaphragmatic hernia masquerading as complicated pneumonia in a young child

Right-sided congenital diaphragmatic hernia masquerading as complicated pneumonia in a young child

Посттравматическая правосторонняя ущемленная диафрагмальная грыжа с аномалиями развития органов брюшной полости

The rarest clinical case of post-traumatic right-sided diaphragmatic hernia complicated by infringement ofthe right lobe of the liver, large and small intestine with necrosis of the large omentum in a patient withsplanchnoptosis is described. A timely diagnosis and surgical intervention - laparotomy, reduction of thestrangulated abnormally located liver, small and half of the colon with resection of the large omentum,thoracocentesis on the right, gastro and colonopexy led to the patient’s recovery. This case may be adescription of interest for abdominal and thoracic surgeons as well.

Liver herniation into the pericardium mimicking a pericardial tumor: unusual presentation of trisomy 13.

Aim of the study: Trisomy 13 is the third most common autosomal trisomy. The following case report shows an atypical case of trisomy 13, highlighting the usefulness of 3D volume storage and reconstruction, and the necessity of careful interpretation of the first trimester screening results. Case description: The results of the first trimester screening tests were interpreted as normal, and invasive tests were not recommended. At 21 weeks, a bright spot in the left ventricle was noted, and fetal echocardiography was performed at 33 weeks. The scan showed a massive pericardial effusion and a pericardial tumor located in front of the right ventricle. Conclusions: The final diagnosis, made postnatally, revealed an atypical right-sided diaphragmatic hernia. Part of the liver was displaced to the pericardial cavity, mimicking a pericardial tumor in a baby with trisomy 13. Following the diagnosis of the lethal disorder, the baby was discharged under a home-based palliative care program and died on the 49th day of life.

VP14.15: Right‐sided anterior congenital diaphragmatic hernia: a malformation which is not always easy to diagnose

Right congenital diaphragmatic hernia (RCDH) accounts for less than 10% of all diaphragmatic defects and is more difficult to detect than left CDH. Antenatal ultrasound provides the opportunity for in utero referral to a tertiary care centre for expert assessment and perinatal management. We present a case of isolated right CDH misdiagnosed during the second trimester ultrasound. A 28-year-old female primgravida, primipara had undergone regular prenatal care. Morphology ultrasound at 22 weeks showed no obvious structural anomalies. The fetal growth was appropriate throughout the pregnancy. A marked left-side deviation of the heart and compression of the right lung were noticed at 33 weeks of gestational ultrasound. To refine the diagnosis we performed a magnetic resonance imaging (MRI). An anterior right-sided diaphragmatic hernia was visualised. There was no herniation of intestines or stomach, but there was an important herniation of the liver into the right thoracic cavity. At a gestational age of 38 weeks a planned Caesarean section was performed and a boy weighing 2920 g was born. Respiratory distress occurred immediately after clamping of the umbilical cord. The new born was immediately intubated by the pediatrician and sent to the intensive care unit for further evaluation. Imaging studies after birth showed a right diaphragmatic hernia with severe pulmonary hypertension and poor lung function. A surgical intervention was planned but he died 24 hours after birth. The prenatal diagnosis of RCDH isn't always easy. The ultrasonography differentiation of the liver from the surrounding bowel and from lung tissue can be quite a challenge even with currently available high-frequency probes. Abnormal axis deviations can suggest an underlying CDH. The MRI can refine the diagnosis.

In-Hospital Morbidities for Neonates with Congenital Diaphragmatic Hernia: The Impact of Defect Size and Laterality

To determine in-hospital morbidities for neonates with right-sided congenital diaphragmatic hernia (R-CDH) compared with those with left-sided defects (L-CDH) and to examine the differential effect of laterality and defect size on morbidities. This retrospective, multicenter, cohort study from the international Congenital Diaphragmatic Hernia Study Group registry collected data from neonates with CDH surviving until hospital discharge from 90 neonatal intensive care units between January 1, 2007, and July 31, 2020. Major pulmonary, cardiac, neurologic, and gastrointestinal morbidities were compared between neonates with L-CDH and R-CDH, adjusted for prenatal and postnatal factors using logistic regression. Of 4123 survivors with CDH, those with R-CDH (n=598 [15%]) compared with those with L-CDH (n=3525 [85%]) had an increased odds of pulmonary (1.7; 95% CI, 1.4-2.2, P<.0001), cardiac (1.4; 95% CI, 1.1-1.8; P=.01), gastrointestinal (1.3; 95% CI, 1.1-1.6; P=.01), and multiple (1.6; 95% CI, 1.2-2.0; P<.001) in-hospital morbidities, with a greater likelihood of morbidity with increasing defect size. There was no difference in neurologic morbidities between the groups. Neonates with R-CDH and a larger defect size are at an increased risk for in-hospital morbidities. Counseling and clinical strategies should incorporate knowledge of these risks, and approach to neonatal R-CDH should be distinct from current practices targeted to L-CDH.

Right-sided congenital diaphragmatic hernia associated with hepatopulmonary fusion and congenital pulmonary malformation

Hepatopulmonary fusion is an uncommon malformation associated with right-sided congenital diaphragmatic hernia. We are presenting a case of a full-term male newborn, who was diagnosed with right sided congenital diaphragmatic hernia. During the surgical procedure, hepatopulmonary fusion was incidentally detected. We aimed to describe a patient clinical manifestation, intraoperative finding and the management dilemma.

Clinical characteristics and outcomes of the right congenital diaphragmatic hernia compared to the left: a 10-year single-center experience.

The features of right-sided congenital diaphragmatic hernias (RCDHs) are quite different from those of left-sided CDHs (LCDHs). We have summarized the features of RCDHs experienced in our institution. This retrospective study analyzed the cases of patients with CDH registered at our institution between 2011 and 2020. Defects on each side were compared based on prenatal diagnosis, medical treatment, type of surgery, and outcomes. A total of 101 patients underwent surgery at our institution during the neonatal period, and 11 had RCDHs. RCDHs and LCDHs were significantly different in terms of extracorporeal membrane oxygenation (36% vs. 6%, p = 0.002), patch repair (81% vs. 28%, p < 0.001), recurrence rate (36% vs. 11%, p = 0.022), and length of hospital stay (117days vs. 51days, p = 0.012). The severity of the fetal diagnosis did not reflect postnatal severity. All patients with RCDH survived to discharge, and there was no significant difference in survival rate between the right and left sides. Neonates with RCDH required more intensive treatments; however, the survival rate was comparable between RCDH and LCDH. RCDH was significantly different from LCDH and an optimal treatment strategy for RCDHs should be established.