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The Journal of Thoracic and... Oct 2011Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on... (Comparative Study)
Comparative Study
OBJECTIVE
Current practice is to repair uncomplicated diaphragmatic hernias (UDHs) to avoid complications such as obstruction or gangrene. However, practice patterns are based on limited data. We analyzed the National Inpatient Sample to compare outcomes of patients with obstructed (ODH) or gangrenous (GDH) diaphragmatic hernias and those who underwent repair of UDHs to perform a risk-benefit analysis of observation versus elective repair.
PATIENTS AND METHODS
We queried the National Inpatient Sample for hospitalized patients who underwent a UDH repair as the principal procedure during their admission. To this repair group, we compared the outcomes of those patients who had a diagnosis of GDH or ODH. A risk-benefit analysis of observation versus elective repair was performed based on these data.
RESULTS
Over a 10-year period, 193,554 admissions for the diagnosis of diaphragmatic hernia were identified. A UDH was the diagnosis in 161,777 (83.6%) admissions with 38,764 (24.0%) admissions for elective repair. ODH or GDH was the reason for admission in 31,127 (16.1%) and 651 (0.3%), respectively. Compared with patients who underwent elective repair, mortality was higher in patients with ODH or GDH (1% vs 4.5%; P < .001; and 1% vs 27.5%; P < .001). Risk-benefit analysis suggested a small but real benefit to elective repair in patients aged 50 to 70 years or if the operative mortality is 1% or less.
CONCLUSIONS
Elective UDH repair is associated with better outcomes than admissions for ODH or GDH with a favorable risk-benefit profile than observation if the operative mortality is low.
Topics: Age Factors; Aged; Aged, 80 and over; Chi-Square Distribution; Databases as Topic; Elective Surgical Procedures; Female; Gangrene; Hernia, Diaphragmatic; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Admission; Patient Selection; Prevalence; Risk Assessment; Risk Factors; Treatment Outcome; United States
PubMed: 21803376
DOI: 10.1016/j.jtcvs.2011.06.038 -
Journal of the American Veterinary... Jul 2018
Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Dyspnea; Female; Hernia, Diaphragmatic; Radiography, Thoracic
PubMed: 29911953
DOI: 10.2460/javma.253.1.35 -
Cirugia Pediatrica : Organo Oficial de... Apr 2020Intrapericardial diaphragmatic hernia is an abdominal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia...
INTRODUCTION
Intrapericardial diaphragmatic hernia is an abdominal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group.
CLINICAL CASE
This is the case of a 4-month-old infant undergoing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiological control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intrapericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications.
DISCUSSION
Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imaging findings are key to perform early diagnosis and surgical treatment.
Topics: Cardiac Surgical Procedures; Gastrointestinal Transit; Heart Diseases; Hernia, Diaphragmatic; Humans; Infant; Male; Pericardium; Postoperative Complications; Radiography
PubMed: 32250073
DOI: No ID Found -
International Surgery 2014We describe the case of a patient with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was successfully treated by...
We describe the case of a patient with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was successfully treated by laparoscopic surgery. A 62-year-old man with a long history of hepatitis C-induced liver cirrhosis was admitted to our institution because of recurrent postprandial periumbilical pain. Eight years earlier, he had undergone radiofrequency ablation for hepatocellular carcinoma at hepatic segment VIII. Computed tomography, gastrografin enema examination revealed transverse colon obstruction because of a diaphragmatic hernia. We diagnosed diaphragmatic hernia associated with the prior radiofrequency ablation treatment. The patient underwent laparoscopic repair of the diaphragmatic hernia. Though the patient experienced the recurrence once, relaparoscopic treatment has improved the patient's conditions. Thus, diaphragmatic hernia can develop as a complication of radiofrequency ablation treatment. A laparoscopic approach is safe, feasible, and minimally invasive, even in patients with cirrhosis who develop iatrogenic diaphragmatic hernia as a complication of radiofrequency ablation treatment.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Diagnosis, Differential; Enema; Hernia, Diaphragmatic; Humans; Iatrogenic Disease; Laparoscopy; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 25058770
DOI: 10.9738/INTSURG-D-14-00025.1 -
Journal of Cardiothoracic Surgery Jul 2021Both diaphragmatic hernia and thoracic gastropericardial fistula rarely occur simultaneously in patients with radical esophagectomy.
BACKGROUND
Both diaphragmatic hernia and thoracic gastropericardial fistula rarely occur simultaneously in patients with radical esophagectomy.
CASE PRESENTATION
A 72-year-old man presented to our hospital with 1 day of nausea, vomiting and acute left chest pain. He had radical esophagectomy (Sweet approach) for esophageal cancer 18 years ago. Computed tomography (CT) of the chest revealed diaphragmatic hernias and air collection within the pericardial space. While an operation of diaphragmatic hernia repair was decisively performed to prevent further serious complications, unusually, a thoracic gastropericardial fistula was also found unusually.
CONCLUSION
Diaphragmatic hernia and thoracic gastropericardial fistula may occasionally coexist in patients with esophagectomy. Upper GI radiograph with a water-soluble contrast agent is a better diagnostic tool than CT in visualizing the fistula.
Topics: Aged; Contrast Media; Esophageal Neoplasms; Esophagectomy; Gastric Fistula; Hernia, Diaphragmatic; Herniorrhaphy; Humans; Male; Pneumopericardium; Radiography; Tomography, X-Ray Computed
PubMed: 34233692
DOI: 10.1186/s13019-021-01574-z -
The Pan African Medical Journal 2015
Topics: Hernia, Diaphragmatic, Traumatic; Humans; Male; Middle Aged; Radiography, Abdominal; Radiography, Thoracic
PubMed: 25995813
DOI: 10.11604/pamj.2015.20.16.5942 -
World Journal of Gastroenterology Aug 2005Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described...
Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare, causes of unexplained angina-like symptoms.
Topics: Aged; Angina Pectoris; Colon; Colonic Diseases; Echocardiography; Hernia, Diaphragmatic; Humans; Male; Tomography, X-Ray Computed
PubMed: 16052699
DOI: 10.3748/wjg.v11.i29.4607 -
Pediatric Clinics of North America Dec 1993Bochdalek hernia is a posterolateral defect in the embryogenesis of the diaphragm. Abdominal contents enter the thorax during fetal development and result in pulmonary... (Review)
Review
Bochdalek hernia is a posterolateral defect in the embryogenesis of the diaphragm. Abdominal contents enter the thorax during fetal development and result in pulmonary hypoplasia. A cause of respiratory distress in the newborn, the management of this disease has undergone dramatic changes. The defect requires surgical repair, but success depends more on preoperative and postoperative management of the associated physiologic derangements.
Topics: Animals; Diagnosis, Differential; Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Models, Biological; Sheep
PubMed: 8255627
DOI: 10.1016/s0031-3955(16)38663-1 -
Journal of Medical Genetics Aug 1976A retrospective anatomical, family, and epidemiological study was made of 143 patients (81 female and 62 male) with diaphragmatic hernia who were born in the south-west...
A retrospective anatomical, family, and epidemiological study was made of 143 patients (81 female and 62 male) with diaphragmatic hernia who were born in the south-west of England between 1943 and 1974. Thirty-nine cases were stillborn. Seventy-five per cent of patients had a left-sided diaphragmatic defect, 22% had a right-sided defect, and 3% had a bilateral defect. Fifty per cent of the patients had other congenital malformations, most frequently of the nervous system. No maternal age or birth order effect was noted. Cases of diaphragmatic hernia without other malformations had in general a normal fetal growth rate. Eight per cent of the cases were illegitimate. There were two pairs of twins discordant for diaphragmatic hernia, one pair being dizygotic and the other monozygotic. In no case of diaphragmatic hernia was there a relative affected with a diaphragmatic hernia. The most common type of diaphragmatic defect was a posterolateral hernia (92%), followed in frequency by an eventration of the diaphragm (5%), the least common defect being a retrocostosternal hernia (2%). Diaphragmatic hernia appears to be aetiologically as well as anatomically heterogeneous. In this series there were two cases of trisomy 18, one case of trisomy 21, one case trisomic for a small part of chromosome 20, and two cases with the Pierre Robin syndrome. It seems likely that diaphragmatic hernia is a non-specific consequence of several teratological processes.
Topics: Abnormalities, Multiple; Birth Order; Birth Weight; Child, Preschool; Chromosome Aberrations; Chromosome Disorders; England; Female; Gestational Age; Hernia, Diaphragmatic; Humans; Infant; Infant, Newborn; Male; Maternal Age; Retrospective Studies; Sex Ratio
PubMed: 957374
DOI: 10.1136/jmg.13.4.253 -
Journal of Pediatric Surgery Mar 1995This report suggests that stabilization of the intrauterine to extrauterine transitional circulation combined with a respiratory care strategy that avoids pulmonary... (Comparative Study)
Comparative Study
This report suggests that stabilization of the intrauterine to extrauterine transitional circulation combined with a respiratory care strategy that avoids pulmonary overdistension, takes advantage of inherent biological cardiorespiratory mechanics, and very delayed surgery for congenital diaphragmatic hernia results in improved survival and decreases the need for extracorporeal membrane oxygenation (ECMO). This retrospective review of a 10-year experience in which the respiratory care strategy, ECMO availability, and technique of surgical repair remained essentially constant describes the evolution of this method of management of congenital diaphragmatic hernia.
Topics: Chest Tubes; Emergencies; Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Respiration, Artificial; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome; Ventilator Weaning
PubMed: 7760230
DOI: 10.1016/0022-3468(95)90042-x