341/781. Laparoscopic repair of Morgagni hernia. BACKGROUND: Morgagni hernia is a rare type of diaphragmatic hernia which represents less than 5% of all congenital diaphragmatic hernias. patients are generally asymptomatic and are diagnosed incidentally. When symptomatic, it generates symptoms due to the compression of thoracic organs or compression of herniated intraabdominal organs. Once diagnosed, the condition requires prompt surgical correction. The defect is repaired either by primary suture or by the use of a prosthetic mesh. In adults, prosthetic mesh repair is preferred. Recently, laparoscopic repair of Morgagni hernia has been introduced and gained wide acceptance. MATERIALS AND methods: Between 2002 and 2004, 5 patients with Morgagni hernia were treated laparoscopically at our department. female/male ratio was 3/2. Mean age was 56 years (range 41 to 69 y). Diagnosis were made by chest x-ray and CT scan. Herniation was on the left in 2 patients, and on the right in 3. The content of hernial sac was transverse colon and stomach. There were 2 separate defects in a patient with left-sided hernia. All cases were laparoscopically treated using prosthetic material. RESULTS: All operations were completed laparoscopically. The postoperative hospital stay was 3 to 5 days with a mean of 4 days. None of the patients developed any complication in the early postoperative period. The mean follow-up period is 7 months (range 3 to 24 mo). All patients are actually in good health and without recurrence. CONCLUSION: Laparoscopic repair of Morgagni hernia is a safe, simple, and reliable procedure which presents all the advantages of the minimally invasive surgery. ( info) |
342/781. Diaphragmatic hernias complicating pregnancy. BACKGROUND: Diaphragmatic hernias complicating pregnancy are not a common problem but they can have catastrophic consequences. They can present to the surgeon as a life-threatening emergency or pose a management dilemma when detected incidentally. In this paper, recommendations for the management of non-hiatal maternal diaphragmatic hernias are made based on our experience and the available published reports. methods: The presentation, management and outcomes of a series of three recent cases are described. A review of all other reported cases of diaphragmatic hernias complicating pregnancy was also carried out. RESULTS: All three cases were emergency presentations in the third trimester of pregnancy, resulting from compression of thoracic contents. All cases required emergency laparotomy and one also required thoracotomy. Delivery was by Caesarean section at the time of emergency surgery in two cases and was delayed in the third case. There was one fetal and no maternal deaths. One mother suffered persistent pleural infection. One baby also had a diaphragmatic hernia requiring postnatal repair. Published reports showed only 36 previously reported cases of diaphragmatic hernias identified in pregnancy. There is a consensus that hernias presenting with evidence of strangulation represent a surgical emergency and mandate operative management, irrespective of fetal maturity. Elective management of asymptomatic hernias is more controversial and both conservative and operative approaches have been suggested. CONCLUSION: Diaphragmatic hernias can cause life-threatening complications in pregnancy. Consideration should be given to operative repair in the second trimester if asymptomatic hernias are identified during pregnancy. If vaginal delivery is attempted in the presence of a hernia, this should only be carried out under closely monitored conditions. ( info) |
343/781. Right congenital diaphragmatic hernia associated with a complex heart disease. A case of right diaphragmatic hernia is presented associated with a complex congenital heart disease (double-outlet right ventricle, transposition of the great arteries and left isomerism) diagnosed prenatally. Despite high-frequency oscillatory ventilation plus nitric oxide and uneventful repair of the hernia, the infant died after 6 days of uncontrolled pulmonary hypertension and severe aortic coarctation that developed postnatally. ( info) |
344/781. Abdominal compartment syndrome after late repair of bochdalek hernia. Abdominal compartment syndrome is a potential complication of laparotomy, but it is rarely anticipated by thoracic surgeons. We present the case of a 16-year-old girl who manifested this syndrome after emergency repair of a Bochdalek congenital diaphragmatic hernia. Techniques for recognition, measurement, treatment, and prevention are discussed. ( info) |
345/781. Bilateral morgagni hernia masquerading as mediastinal mass. Bilateral Morgagni hernia is a rare entity. A patient of bilateral Morgagni hernia presenting as mediastinal mass is being reported. The hernial contents included transverse colon so the diagnosis could be confirmed preoperatively by barium enema. Surgery was curative. ( info) |
| wolf-hirschhorn syndrome (WHS) is a rare distinct clinical entity caused by a deletion of the short arm of chromosome 4. We report a case in which intrauterine growth restriction (IUGR), severe oligohydramnios, left-sided congenital diaphragmtic hernia (CDH), and cystic hygroma were detected by prenatal ultrasound examination at 27 weeks of gestation. A 29-year-old gravida 3, para 2, woman was referred at 26 weeks' gestation with suspicion of IUGR and cystic hygroma. Sonographic examination revealed IUGR with severe oligohydramnios, increased nuchal fold with cystic hygroma (left-sided diaphragmatic defect of Bochdalek type), and congenital diaphragmatic hernia. Chromosome analysis revealed a 46, XX, del(4)(p15.2) karyotype. autopsy confirmed the ultrasound findings. Congenital diaphragmatic hernia (CDH) has rarely been described to be associated with WHS. CDH and cystic hygroma can lead to a diagnosis of this syndrome very early in life. We recommend genetic evaluation of a fetus with cystic hygroma, IUGR and CDH taking into consideration 4p deletion syndrome. ( info) |
347/781. Diaphragmatic hernia after right donor and hepatectomy: a rare donor complication of partial hepatectomy for transplantation. BACKGROUND: Because of the critical worldwide shortage of cadaveric organ donors, transplant professionals have increasingly turned to living donors. Partial hepatectomy for adult living donor liver transplantation has been performed since the late 1990s. Most often, the complications of living donor hepatectomy have been related to the biliary tract, specifically biliary leaks. methods: A 54-year-old man underwent donor right hepatectomy for living donor liver transplantation. Three years after liver donation he presented with upper abdominal pain and fullness. Radiographic workup revealed a diaphragmatic hernia of the right hemithorax. RESULTS: After thoracoscopic evaluation of the right hemithorax, diaphragmatic hernia was repaired. Currently the patient remains well several months after the repair with complete resolution of abdominal pain, normal chest X-ray examination demonstrating no recurrence of diaphragmatic hernia, and normal liver functions tests. CONCLUSIONS: Multiple complications of living donor liver transplantation have been described the transplant literature. Diaphragmatic hernia is a formerly-undescribed complication of right donor hepatectomy for transplantation. ( info) |
348/781. Congenital diaphragmatic hernia: two case studies with atypical presentations. Congenital diaphragmatic hernia (CDH) affects 1 in every 2,000 to 4,000 live births. Many infants with this condition are diagnosed antenatally through routine ultrasound screening. Nearly 90 percent present at delivery with severe respiratory distress requiring intubation. Many of these infants develop persistent pulmonary hypertension of the newborn due to hypoplasia of the affected lung. The survival of infants with CDH is limited by the degree of pulmonary hypoplasia and requires sophisticated medical technology such as high-frequency ventilation and inhaled nitric oxide. Some infants also require treatment with extracoporeal membrane oxygenation. This article gives details of two cases of CDH in which the presentation was atypical. The more subtle presentation is discussed, as well as the embryology and pathophysiology of CDH and the possibility of associated anomalies. Clinical management and impact on the family are outlined. ( info) |
349/781. Iatrogenic diaphragmatic hernia due to laparoscopic gastric banding. A patient developed a huge diaphragmatic hernia following laparoscopic gastric banding. Almost the entire stomach was incarcerated within the left chest. Segmental necrosis of the greater curvature of the stomach necessitated partial gastrectomy. The postoperative course was uneventful. The etiology, diagnosis and treatment of this previously undescribed complication of laparoscopic gastric banding are addressed in relation to the present case. ( info) |
350/781. Congenital intrathoracic kidney with right Bochdalek defect. Intrathoracic kidney is a rare congenital anomaly. Since most reported cases are asymptomatic, it is extremely rare for this ectopia to be diagnosed in the neonatal period. We report a male infant with right intrathoracic kidney associated with Bochdalek defect. Chest X-ray demonstrated a right posterior mediastinal mass and intestinal gas in the right lung field. Contrast-enhanced CT and intravenous urography led to a diagnosis of intrathoracic kidney. Due to the presence of Bochdalek defect, the intrathoracic kidney was reduced into the abdominal cavity at the time of diaphragmatic repair. The intrathoracic kidney with attached adrenal gland was located at the level of the carina and was covered with protruded retroperitoneum. The kidney was thought to have been pushed this high by the small intestine and left lobe of the liver, which had also herniated through the defect. Postoperative hemodynamics and renal function were normal. ( info) |