1/7. Diaphragmatic herniation after transhiatal esophagectomy.Increasing experience with transhiatal esophagectomy (THE) has brought with it a good understanding of the advantages and disadvantages of the technique. As in our case, diaphragmatic hernias after THE may result from excess manipulation and extension of the hiatus during surgery. The varying nature of the clinical presentation may cause delay in diagnosis. We report our case and discuss how to diagnose and manage this complication under the sum of cases reported previously in English literature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Necrotic gangrenous intrathoracic appendix in a marfanoid adult patient: a case report.BACKGROUND: A diaphragmatic hernia is defined as a defect in part of the diaphragm through which abdominal contents can protrude into the thorax. It may be congenital or acquired. In this case report, we aim to demonstrate a congenital diaphragmatic hernia in an adult marfanoid patient which required emergency treatment CASE PRESENTATION: A 43 year old woman was admitted with classical appendicitis requiring surgery. She incidentally had Marfan's clinical features with a positive family history for the syndrome. At operation she had grossly abnormal abdominal anatomy. Radiological investigations demonstrated a large right congenital diaphragmatic hernia with an intrathoracic hernial sac containing a perforated gangrenous appendix. The hernial sac was opened surgically and the appendix excised. The patient made a full recovery. CONCLUSION: Diaphragmatic hernias are usually congenital in nature often requiring early corrective surgery for future survival. We have demonstrated the presence of an unusually large diaphragmatic defect, almost a hemidiaphragmatic defect, of unknown direct etiology, but of some possible association with Marfan's syndrome in an adult patient presenting with an acute perforated gangrenous appendix requiring emergency life-saving surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/7. Stabbing chest pain: a case of intermittent diaphragmatic herniation.A case of traumatic diaphragmatic herniation is described in which gross mediastinal shift was caused by a combination of the herniated abdominal organs, purulent exudate, and air. This complex presentation might best be described as a case of gastrocolopyopneumothorax, diagnosis of which was further complicated by the intermittent nature of the herniation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. Laparoscopic patch repair of diaphragmatic hernias with Surgisis.BACKGROUND: Laparoscopic repair of congenital diaphragmatic hernias has been sparsely reported. Moreover, each report has primarily been a single operative case. In most of the reports, prosthetic mesh has not been used, and when used, it has been nonabsorbable in nature. Most of these case reports have documented only a few months of clinical follow-up. methods: After institutional review board approval (No. 01-12-115X), the clinical course and outcome of 3 patients undergoing laparoscopic repair of foramen of Morgagni and Bochdalek hernias using 4-ply Surgisis soft tissue graft (Cook Inc, Bloomington, Ind) were reviewed to determine if this approach is appropriate. RESULTS: In 2001, 2 patients, ages 9 months and 14 years, underwent laparoscopic foramen of Morgagni repair and one 5-day-old underwent laparoscopic foramen of Bochdalek repair using Surgisis soft tissue graft as a patch to close the diaphragmatic defects because there was too much tension with primary repair. In each case, the prosthesis was secured to the rim of the defect using interrupted silk sutures tied intracorporally. The mean operative time for repair of the Morgagni defects was 230 minutes with a postoperative discharge of 1 and 2 days. For the foramen of Bochdalek repair, the operative time was 204 minutes, and the patient was discharged at 3 weeks. No complications have occurred during or after any of the procedures, but the oldest patient underwent diagnostic laparoscopy 3 months postoperatively for a radiographic finding of suspected recurrence. At laparoscopy, the patch was intact, and no diaphragmatic hernia was noted. CONCLUSIONS: Laparoscopic repair of congenital diaphragmatic defects using prosthetic material is possible although the operative time required is around 3.5 hours. Because of the brief postoperative course, the laparoscopic approach appears justified in the nonneonatal patients. Whether this approach is appropriate for repair of neonatal Bochdalek hernias remains unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. Antenatal ultrasonographic diagnosis of a congenital posterolateral diaphragmatic defect.The antenatal ultrasonographic findings in a fetus with a left-sided congenital posterolateral diaphragmatic defect (CPLDD) are presented and discussed. Displacement of the heart towards the right and absence of a normally positioned fluid-filled stomach at repeated examinations are diagnostic. In the event of an intrathoracically displaced fetal stomach, which occurs in about 60% of the cases, a sonolucent area in the left chest may be found. In view of the dynamic nature of fetal stomach filling, more than one examination may be required to detect this feature. Antenatal recognition of congenital diaphragmatic hernia (CDH) has important consequences for perinatal management and can improve neonatal outcome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. The incidence and spectrum of neurological injury after open fetal surgery.A preterm infant's immature brain is susceptible to both anoxic and hemorrhagic injury during periods of physiological stress. The advent of in utero surgery has created a new population of premature patients at risk for central nervous system (CNS) injury. The aim of this study was to evaluate the frequency and nature of CNS injuries in fetal surgical patients. Of 33 fetuses with known neurological outcome after fetal surgery, CNS injuries were identified in seven (21%). Of the seven, four had significant episodes of fetal bradycardia (3) or neonatal hypotension (1), which suggests that asphyxia contributed to the neurological injury. The CNS injuries in the other three patients occurred unexpectedly and without associated signs of fetal distress. The authors speculate that these injuries may have been caused by sudden fluxes in cerebral blood flow, induced by maternal hypoxia (1) or by maternally administered tocolytic drugs (2) used to treat postoperative preterm labor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Congenital diaphragmatic hernia associated with aortic coarctation.Congenital diaphragmatic hernia (CDH) may be associated with other anomalies, most frequently cardiovascular in nature. Despite fetal echocardiography, diagnosis of an accompanying cardiac malformation often is not made until after birth and sometimes not until after extracorporeal membrane oxygenation (ECMO) has been instituted. aortic coarctation associated with CDH may occur as an isolated, surgically correctable malformation or it may be a component of the usually fatal left heart "hypoplasia" or "smallness" syndrome. The authors present two cases of aortic coarctation associated with CDH requiring ECMO that illustrate the management challenges of these coincident diagnosis. In one case, the accompanying coarctation was suspected and required precannulation angiography for confirmation, whereas in the other case, the diagnosis of coarctation was not made until after ECMO cannulation. Depending on its anatomic location and severity, an aortic coarctation associated with life-threatening CDH may limit the physiological efficacy of venoarterial ECMO. Furthermore, arterial cannulation for extracorporeal support requires that flow through the remaining carotid artery be maintained during aortic reconstruction, which may prove difficult for lesions best treated by subclavian flap angioplasty. When the diagnosis of coincident aortic coarctation and CDH is suspected or proven before institution of extracorporeal support, serious consideration should be given to venovenous bypass, because this may provide better postductal oxygenation and facilitate aortic repair with the option of left carotid artery inflow occlusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |