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The American Journal of Medicine Apr 2024
PubMed: 38582321
DOI: 10.1016/j.amjmed.2024.03.037 -
Turk Pediatri Arsivi Dec 2018Bochdalek hernias, which brought after the neonatal period, are also late-defined cases. In this study, we aimed to present the clinical characteristics of patients with...
AIM
Bochdalek hernias, which brought after the neonatal period, are also late-defined cases. In this study, we aimed to present the clinical characteristics of patients with late-presentation Bochdalek hernias who underwent surgery in a reference hospital and our experience regarding their diagnosis.
MATERIAL AND METHODS
Patients with late-presentation Bochdalek hernia who underwent surgery in our clinic between 2001 and 2016 were analyzed retrospectively in terms of the causes of the delay in diagnosis, symptoms, and radiologic and surgical results.
RESULTS
A total of seven patients with late-presentation Bochdalek hernia underwent surgery, four males and three females. The median age was 48 months. Of the 43 patients who underwent surgery for Bochdalek hernia during the same period, 7 (16.27%) presented to hospital late. In all late-presentation Bochdalek hernia cases, the defect was on the left side. Two patients had hernia sacs, and two patients had ectopic intrathoracic left kidneys. Six of the patients presented with gastrointestinal system symptoms, and one with respiratory system symptoms. The median time between the onset of symptoms and diagnosis was 60 days. The maternal age of four patients was ≥30 years. The gestational age and birth weights of the patients were normal. In physical examination, there was a scaphoid abdomen and an increased chest anterior-posterior diameter. In chest radiographs of all patients, the appearance was consistent with intestinal gas in the left hemithorax. The transverse length of the defect in the diaphragm (median value: 5 cm) in the patients with late-presentation Bochdalek hernia was longer than that (median value: 3 cm) of patients who were diagnosed early (p=0.02). The difference was statistically significant. All patients survived, were followed up for an average of 3 years, and no relapse was observed during the follow-up period.
CONCLUSION
Bochdalek hernia can be diagnosed after the neonatal period. Contrary to cases diagnosed in the neonatal period, gastrointestinal system symptoms are at the forefront in these cases, and these patients have good prognosis. Congenital diaphragmatic hernia should be considered in the differential diagnosis in patients with gastrointestinal system symptoms such as recurrent nausea and vomiting.
PubMed: 30872927
DOI: 10.5152/TurkPediatriArs.2018.0039 -
BMJ Case Reports Nov 2021Tension gastrothorax is a form of obstructive shock resulting from increased intrathoracic pressure due to a distended herniated stomach. The clinical features of...
Tension gastrothorax is a form of obstructive shock resulting from increased intrathoracic pressure due to a distended herniated stomach. The clinical features of tension gastrothorax are similar to the clinical features of the more common tension pneumothorax. Clinical recognition of this trauma has remained difficult especially in the tropics where most responders are not specialists. We managed a 31-year-old male who, in addition to typical features of obstructive shock secondary to increased intrathoracic pressures, had a recent meal prior to the trauma and a scaphoid abdomen at presentation. We argue that a history of a recent meal before trauma and an unusually scaphoid abdomen could be suggestive of tension gastrothorax and may help to differentiate it from tension pneumothorax. We recommend improved emergency preparedness to help recognise and treat this pathology.
Topics: Adult; Africa South of the Sahara; Humans; Male; Pneumothorax; Shock
PubMed: 34848419
DOI: 10.1136/bcr-2021-246101 -
AME Case Reports 2021We are presenting the case of a 6-year-old male patient with progeroid phenotype and severe developmental delay referred to Genetic clinic. Given the complex phenotype...
We are presenting the case of a 6-year-old male patient with progeroid phenotype and severe developmental delay referred to Genetic clinic. Given the complex phenotype an extensive metabolic and genetic evaluation was performed including a whole exome sequencing analysis that showed genetic variants in , and genes. Patients' mother and brother were analyzed for the genetic variants in and . Both had same variants on and as our patient, with no apparent phenotypical consequences. Physical examination was remarkable for dysmorphism including plagiocephaly, low set and abnormally shaped ears, up slanted palpebral fissures, hypoplastic alae nasi, and a head circumference two standard deviations below the 3 percentile (microcephaly). Other characteristics include wrinkled skin, a broad forehead, sparse eyelashes in lower eyelid, short palpebral fissures, upturned nares, thick lips, right occipital plagiocephaly, overfolded helix and prominent anti-helix, protuberant chest, scaphoid abdomen, digitalized thumbs, and kyphosis due to low muscle tone. The patient presented abnormal EEG with evidence of epileptic discharges. A temporal bone CT showed plagiocephaly with flattening of the right occipital bone. Brain MRI showed callosal agenesis with bilateral colpocephaly with temporal horn dilatation, parahippocampal atrophy, lissencephaly and midbrain hypoplasia. The combination of gene variants mentioned above has never been reported nor correlated as the result of haploinsufficiency mechanisms. Thus, we propose haploinsufficiency and loss of heterozygosity as etiological reasons for this patient phenotype. Further proteomic studies are needed to allocate the extense of genetic influence within the clinical manifestations.
PubMed: 34805759
DOI: 10.21037/acr-21-25 -
Sultan Qaboos University Medical Journal Feb 2016Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete...
Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete congenital diaphragmatic agenesis using a combination of autologous living bio-tissue and synthetic mesh in a neonate born in the NMC Specialty Hospital in Dubai, United Arab Emirates, in May 2014. Poor Apgar scores, a scaphoid abdomen and absent breath sounds over the right hemithorax were observed at birth. Chest and abdominal X-rays revealed a diaphragmatic hernia. The neonate was stabilised using high-frequency oscillatory ventilation, nitric oxide and sildenafil. The right diaphragm was reconstructed using combined latissimus dorsi and serratus anterior muscle flaps reinforced by a flexible composite mesh. At 12 months old, the infant had normal respiratory function and the diaphragm was intact. No disabilities of the shoulder or scapula were observed. This case indicates that a combination of living tissue and synthetic mesh can be used to reconstruct a functional diaphragm with efficient pleuroperitoneal separation.
PubMed: 26909223
DOI: 10.18295/squmj.2016.16.01.018 -
BMJ Case Reports May 2013A 7-week-old baby presented to a district general hospital with a history of pallor, lethargy, vomiting and high pitched cry. She had vomited three times at home. It was...
A 7-week-old baby presented to a district general hospital with a history of pallor, lethargy, vomiting and high pitched cry. She had vomited three times at home. It was reported that the last vomitus had a greenish tinge to it. In hospital, she had a non-bilious vomit. There was no history of fever, constipation or diarrhoea. Her birth history and medical history were unremarkable. She was noted to be pale, lethargic and quiet on examination. Her vital signs were unremarkable. She had a soft scaphoid abdomen on examination. No masses were palpable. Investigations for sepsis were done and antibiotics started. Results of all the investigations were normal apart from mildly raised blood glucose and neutrophilia. Later on she passed a small amount of blood per rectum. Examination revealed a palpable mass in the epigastrium. An abdominal x-ray was suggestive of intestinal obstruction. Intussusception was confirmed on ultrasound. The intussusception was successfully reduced following surgery.
Topics: Female; Humans; Ileal Diseases; Infant; Intussusception
PubMed: 23682081
DOI: 10.1136/bcr-2012-008518 -
California Medicine Feb 1960Vomiting or its lesser stages-anorexia, nausea-is a prime symptom of the most serious surgically curable diseases of childhood. In the newborn, when vomitus is green,...
Vomiting or its lesser stages-anorexia, nausea-is a prime symptom of the most serious surgically curable diseases of childhood. In the newborn, when vomitus is green, abdomen scaphoid, and erect roentgen view shows air-fluid levels in stomach and duodenum with gas beyond, partial duodenal obstruction is present and midgut volvulus with malrotation is likely enough to justify immediate exploration. In infancy, vomiting is a clear sign of intussusception when associated with intermittent colicky pain, palpable mass and "currant-jelly" feces. These symptoms are not always present, and if there is blood in the feces, barium enema study must follow. In further doubt, exploration may be justified. In childhood, a common early symptom of appendicitis is vomiting accompanied by pain without any complete remission. Constipation is frequent but diarrhea may occur and contribute to an impression of gastroenteritis. Complete and repeated physical examination, with a history of the above symptoms, should lead to correct diagnosis.
Topics: Abdominal Pain; Appendicitis; Child; Constipation; Diarrhea; Digestive System Abnormalities; Duodenum; Enema; Feces; Gastroenteritis; Humans; Infant; Infant, Newborn; Intestinal Volvulus; Intussusception; Nausea; Pain; Physical Examination; Vomiting
PubMed: 13829164
DOI: No ID Found