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Journal of Pediatric Surgery Jun 2011Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term... (Comparative Study)
Comparative Study
PURPOSE
Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.
METHODS
Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques.
RESULTS
Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P < .05). Minimally invasive surgery demonstrated a significant increased odds for recurrence (odds ratio, 3.59; 95% confidence interval, 1.92-6.71) after adjusting for gestational age, birth weight, patch repair, and extracorporeal membrane oxygenation.
CONCLUSION
Minimally invasive techniques appear to have a significant higher recurrent hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization.
Topics: Analysis of Variance; Cohort Studies; Confidence Intervals; Female; Follow-Up Studies; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Laparoscopy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Odds Ratio; Postoperative Complications; Registries; Reoperation; Secondary Prevention; Survival Rate; Thoracoscopy; Treatment Outcome; United States
PubMed: 21683215
DOI: 10.1016/j.jpedsurg.2011.03.050 -
Journal of Pediatric Surgery Feb 2009Prof. Donahoe outlines her career-long interest in congenital diaphragmatic hernia and how this has led to her current investigations into its etiology and possible...
Prof. Donahoe outlines her career-long interest in congenital diaphragmatic hernia and how this has led to her current investigations into its etiology and possible treatment using gene probes.
Topics: Child; General Surgery; Genomics; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Pediatrics
PubMed: 19231523
DOI: 10.1016/j.jpedsurg.2008.10.077 -
BMJ Case Reports Jul 2020A 78-year-old man with no surgical history or recent trauma presented to the emergency department with sudden onset right-sided chest pain and dyspnoea. He was admitted...
A 78-year-old man with no surgical history or recent trauma presented to the emergency department with sudden onset right-sided chest pain and dyspnoea. He was admitted under the physicians for investigations and was subsequently diagnosed with empyema of the right thorax. After no improvement with intravenous antibiotics, a chest drain was inserted; no pus was drained. He worsened clinically; a repeated CT scan demonstrated an incarcerated loop of small bowel within the right thoracic cavity secondary to a diaphragmatic hernia (DH). The patient had emergency surgery to remove necrotic small bowel and to lavage the thorax. Strangulated DH should be considered as a differential diagnosis where presentation is unusual and empyema does not improve after initial management.
Topics: Aged; Diagnosis, Differential; Empyema, Pleural; Hernia, Diaphragmatic; Humans; Intestine, Small; Male; Necrosis; Thoracic Cavity
PubMed: 32641313
DOI: 10.1136/bcr-2019-233440 -
Journal of Medical Case Reports Aug 2021Bochdalek diaphragmatic hernia is a developmental defect of the posterolateral portion of the diaphragm. This defect may allow abdominal contents to abnormally occupy...
BACKGROUND
Bochdalek diaphragmatic hernia is a developmental defect of the posterolateral portion of the diaphragm. This defect may allow abdominal contents to abnormally occupy the thoracic cavity, resulting in most cases in the compression of the developing lungs. Signs are typically shown during early childhood since the defect is usually present during development. In exceptional cases, however, Bochdalek diaphragmatic hernia can be observed in asymptomatic adult patients, or in those whose initial diagnosis may include common respiratory pathologies such as asthma.
CASE PRESENTATION
Here we describe the case of a 31-year-old Mestizo female patient admitted to the emergency room owing to sudden onset of pain in the left hypochondrium and in epigastrium, as well as signs of respiratory distress. Soon after admission, the patient entered cardiorespiratory arrest, and advanced cardiac life support was provided for 45 minutes without success. The patient was declared dead 1 hour 40 minutes after admission. Clinical autopsy concluded that cause of death was respiratory failure as a complication of a previously undiagnosed Bochdalek diaphragmatic hernia.
CONCLUSIONS
We report an exceptional case of Bochdalek diaphragmatic hernia as the cause of rapid-onset respiratory failure and death in an adult. Unfortunately, due to its unusual presentation, Bochdalek diaphragmatic hernia is rarely considered among the list of differential diagnoses when admitting an adult patient with respiratory symptoms. By reporting this case, we encourage the medical community and trainees to consider diaphragmatic defects when approaching a patient with sudden onset of abdominal pain with concomitant respiratory symptoms.
Topics: Adult; Autopsy; Child, Preschool; Diaphragm; Dyspnea; Female; Hernia, Hiatal; Hernias, Diaphragmatic, Congenital; Humans
PubMed: 34353367
DOI: 10.1186/s13256-021-02907-1 -
Neonatal congenital diaphragmatic hernia: defining criteria to define the optimal timing for repair.Minerva Anestesiologica Oct 2012
Topics: Blood Gas Analysis; Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Male; Respiratory Mechanics
PubMed: 23059511
DOI: No ID Found -
Journal of the National Medical... Sep 1979
Topics: Adult; Cysts; Diagnosis, Differential; Female; Hernia, Diaphragmatic; Humans; Infant, Newborn; Lung; Lung Diseases; Pregnancy; Radiography
PubMed: 501759
DOI: No ID Found -
Journal of Korean Medical Science Jun 2013The aims of this study were to investigate whether early arterial blood gas analysis (ABGA) could define the severity of disease in infants with congenital diaphragmatic...
A simplified formula using early blood gas analysis can predict survival outcomes and the requirements for extracorporeal membrane oxygenation in congenital diaphragmatic hernia.
The aims of this study were to investigate whether early arterial blood gas analysis (ABGA) could define the severity of disease in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective study over a 21-yr period of infants diagnosed with CDH. Outcomes were defined as death before discharge, and extracorporeal membrane oxygenation requirements (ECMO) or death. A total 114 infants were included in this study. We investigated whether simplified prediction formula [PO2-PCO2] values at 0, 4, 8, and 12 hr after birth were associated with mortality, and ECMO or death. The area under curve (AUC) of receiver operating characteristic curve was used to determine the optimum ABGA values for predicting outcomes. The value of [PO2-PCO2] at birth was the best predictor of mortality (AUC 0.803, P < 0.001) and at 4 hr after birth was the most reliable predictor of ECMO or death (AUC 0.777, P < 0.001). The value of [PO2-PCO2] from ABGA early period after birth can reliably predict outcomes in infants with CDH.
Topics: Algorithms; Area Under Curve; Blood Gas Analysis; Extracorporeal Membrane Oxygenation; Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Male; Predictive Value of Tests; ROC Curve; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 23772159
DOI: 10.3346/jkms.2013.28.6.924 -
Surgery Aug 2010Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in...
BACKGROUND
Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR).
METHODS
Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as <37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were performed.
RESULTS
During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34-2.11).
CONCLUSION
Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH.
Topics: Extracorporeal Membrane Oxygenation; Female; Gestational Age; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Infant, Premature; Male; Odds Ratio; Pregnancy; Prognosis; Prospective Studies; Registries; Survival Analysis; Treatment Outcome
PubMed: 20471048
DOI: 10.1016/j.surg.2010.03.018 -
Overview of epidemiology, genetics, birth defects, and chromosome abnormalities associated with CDH.American Journal of Medical Genetics.... May 2007Congenital diaphragmatic hernia (CDH) is a common and well-studied birth defect. The etiology of most cases remains unknown but increasing evidence points to genetic... (Review)
Review
Congenital diaphragmatic hernia (CDH) is a common and well-studied birth defect. The etiology of most cases remains unknown but increasing evidence points to genetic causation. The data supporting genetic etiologies which are detailed below include the association of CDH with recurring chromosome abnormalities, the existence of CDH-multiplex families, and the co-occurrence of CDH with additional congenital malformations.
Topics: Abnormalities, Multiple; Cardiovascular Abnormalities; Chromosome Aberrations; Chromosomes, Human, Pair 15; Congenital Abnormalities; Family Health; Hernia, Diaphragmatic; Humans; Meta-Analysis as Topic; Prevalence
PubMed: 17436298
DOI: 10.1002/ajmg.c.30126 -
The Western Journal of Medicine Nov 1984
Topics: Hernia, Diaphragmatic; Hernia, Hiatal; Humans; Infant
PubMed: 6516344
DOI: No ID Found