1
|
Guo R, Zhang L, Zhang S, Xu H, Zhai Y, Zhao H, Lv L. Case report: Emergency treatment of late-presenting congenital diaphragmatic hernia with tension gastrothorax in three Chinese children. Front Pediatr 2023; 11:1115101. [PMID: 36816375 PMCID: PMC9929136 DOI: 10.3389/fped.2023.1115101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/13/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a scarce birth defect. It is called late-presenting CDH when symptoms are found after 1 month of life. The clinical manifestations of late-presenting CDH are diverse, among which the most fatal is the cardiac arrest caused by tension gastrothorax. The disease is rare, can easily lead to death owing to improper emergency treatment. This report illustrates the emergency treatment of late-presenting CDH with tension gastrothorax in three Chinese children. CASE REPORTS AND MANAGEMENT Three children presented to emergency room with a sudden dyspnea, diagnosed accurately by x-ray or computed tomography. In case 1, the gastric tube could not be inserted at the first attempt, and the child cried incessantly. Cardiac arrest occurred when the gastric tube was re-inserted. After cardiopulmonary resuscitation and placement of a thoracic drainage tube, a large amount of gas and stomach contents were drained. Laparoscopic surgery was performed. The patient died of sepsis. In case 2, the gastric tube could not be inserted at the first attempt; consequently, emergency surgery was considered instead of retrying. After the patient was anesthetized, a gastric tube was successfully placed. Subsequently, a large amount of gas and gastric contents was drained, and thoracoscopic surgery was performed. The patient recovered evenly. In case 3, the gastric tube was successfully inserted at the first attempt; however, the vital signs were unstable due to poor drainage of the gastric tube. We injected 20 ml of iohexol into the stomach tube for angiography and dynamic chest film monitoring. After adjusting the position of the stomach tube, the stomach collapsed completely. Thoracoscopic surgery was performed. The patient recovered evenly. CONCLUSION Early diagnosis is essential for children with late-presenting CDH complicated by tension gastrothorax. Fully collapsing the stomach is a key step in emergency treatment. In addition, gastric tube insertion is the first choice. In children with difficulty in gastric tube placement at the first attempt, the gastric tube can be placed under anesthesia, and emergency surgery performed simultaneously. Endoscopic surgery can be the first choice in cases of complete stomach collapse.
Collapse
Affiliation(s)
- Rui Guo
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| | - Lina Zhang
- Department of Emergency, Zhangqiu Dist Peoples Hospital, Jinan, China
| | - Shisong Zhang
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| | - Hongxiu Xu
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| | - Yunpeng Zhai
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| | - Huashan Zhao
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| | - Longfei Lv
- Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China
| |
Collapse
|
2
|
Sunnapwar A, Ojili V, Katre R, Shah H, Nagar A. Multimodality imaging of adult gastric emergencies: A pictorial review. Indian J Radiol Imaging 2021; 27:13-22. [PMID: 28515579 PMCID: PMC5385768 DOI: 10.4103/0971-3026.202957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
Collapse
Affiliation(s)
- Abhijit Sunnapwar
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rashmi Katre
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hardik Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Arpit Nagar
- Department of Body Imaging, Ohio State University Wexner Medical Center, Ohio, USA
| |
Collapse
|
3
|
AlSadhan R, Alaraifi AK, Abdulatif M. Short bowel syndrome as an unusual complication of strangulated congenital diaphragmatic hernia: Case report. Int J Surg Case Rep 2020; 73:125-129. [PMID: 32682322 PMCID: PMC7365962 DOI: 10.1016/j.ijscr.2020.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/27/2020] [Accepted: 06/27/2020] [Indexed: 11/21/2022] Open
Abstract
Congenital diaphragmatic hernia is a rare cause of neonatal bowel obstruction. Congenital diaphragmatic hernia is associated with many long-term complications involving multiple systems. Only few cases in the literature has reported a strangulated congenital diaphragmatic hernia and even a fewer ones required bowel resection. Short bowel syndrome is an unlikely outcome of strangulated congenital diaphragmatic hernia, requiring feeding by total parenteral nutrition.
Introduction Strangulation is a rare complication of congenital diaphragmatic hernia (CDH). There are few cases in the literature describing strangulated CDH. However, none of them was a recurrence of a previously repaired defect nor resulted in short bowel syndrome. Presentation of case We report an unusual case of newborn presenting with CDH that was repaired shortly after birth but developed recurrence with strangulation few months after, requiring a massive resection, resulting in short bowel syndrome (SBS). It was managed via total parenteral nutrition feeding for three months until the patient was able to tolerate orally. Discussion There were one familiar case in the reported literature by Woolley of an infant developing bowel infraction as a result of CDH where he later developed short bowel syndrome. Conclusion Short bowel syndrome is an unlikely outcome of strangulated CDH. Early repair of the defect should be promoted to avoid the devastating consequences of an CDH similar to the ones encountered in our case. High index of suspicion should be kept during the follow-up of patients with CDH post repair to detect early signs of recurrences.
Collapse
Affiliation(s)
- Reema AlSadhan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Abdulaziz K Alaraifi
- Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Magdy Abdulatif
- Department of Pediatric Surgery, Maternity and Children Hospital, Al Ahsa, Saudi Arabia.
| |
Collapse
|
4
|
Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol 2019; 60:634-640. [PMID: 30992193 DOI: 10.1016/j.pedneo.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To describe the characteristics, treatments, and prognosis of pediatric gastric perforation patients beyond neonatal period. METHODS Twenty pediatric patients beyond neonatal period were included in this study. Medical records were reviewed and clinical characteristics were analyzed. According to the outcomes, patients were divided into the survival group and the death group. Death time was documented, and survival patients were followed up. The degree of severity was calculated using pediatric critical illness score (PCIS). Differences between the two groups were analyzed by the Student's t-test, Mann-Whitney test and Chi-square test appropriately. RESULTS Gastric perforation was diagnosed in 20 pediatric patients beyond neonatal period, including 6 males (30%) and 14 females (70%), with the age of 37.18 (15.90, 107.12) months, and the range was from 4.30 months to 14.17 years old. They had different manifestations, etiologies, sites of perforation and surgery procedures. Among the 20 cases, 14 (70%) survived and 6 (30%) died. Age, gender, length and number of perforation had no statistically difference between the two groups. However, PCIS, ischemia of gastrointestinal wall, and transmural necrosis of gastric wall were statistically different. For the survival group, during a follow-up period of 50 (36, 68) months, ranging from 2 months to 8 years and 7 months, one patient had a second-time perforation, another 3 patients had brain injury symptoms, and the rest 10 patients had good quality of lives. CONCLUSIONS Gastric perforation of pediatric patients beyond neonatal period causes a mortality of 30% on this study. Spontaneous great curvature of gastric wall perforation has the highest morbidity. Low PCIS predicts for unfavorable prognosis. Most of the survival patients have satisfactory living quality after operation.
Collapse
|
5
|
Pre- and neonatal imaging of gastrointestinal complications in congenital diaphragmatic hernia. Abdom Radiol (NY) 2018; 43:574-582. [PMID: 28695234 DOI: 10.1007/s00261-017-1246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The initial outcome in infants with congenital diaphragmatic hernia is mainly related to the associated lung hypoplasia. However, these patients frequently present with additional gastrointestinal pathology that also influences their quality of life and final prognosis. Congenital gastrointestinal anomalies are often observed and the displacement of the liver, the stomach and/or the intestines into the thorax may cause distortion of the vascular axis of these organs, increasing the risk of congestion and/or ischemia. Some of these gastrointestinal complications are already visible at imaging studies performed in utero and/or in newborns.This pictorial essay describes the imaging findings of the most frequently detected gastrointestinal complications in fetuses and infants with congenital diaphragmatic hernia, focusing on prenatal exams.
Collapse
|
6
|
Tan ET, Sloan K, Lakhoo K. An Unusual Complication of Congenital Diaphragmatic Hernia. European J Pediatr Surg Rep 2017; 5:e65-e67. [PMID: 29250478 PMCID: PMC5659859 DOI: 10.1055/s-0037-1607353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/09/2017] [Indexed: 11/01/2022] Open
Abstract
A term newborn was referred to our unit with a postnatal diagnosis of a right-sided congenital diaphragmatic hernia (CDH). She was managed with high-frequency oscillatory ventilation, inotropic support, and nitric oxide, with planned surgical repair when she was medically optimized. On day 6 of life, there was an acute deterioration causing difficulty maintaining adequate ventilation and the infant requiring increasing analgesia and paralysis, especially during abdominal examination. A repeat X-ray showed distended bowel loops in the right hemithorax when compared with previous films raising suspicion of bowel obstruction. The infant proceeded to emergency laparotomy in the neonatal intensive care unit. She was found to have a right-sided Bochdalek (posterolateral) defect. The entire small bowel was within the thoracic cavity and appeared dusky secondary to obstruction caused by compression of a herniated right liver lobe against the hernia defect. Bowel perfusion improved after reduction and a BioDesign patch was used to repair the defect. The infant went on to have a straightforward recovery and was transferred to her local hospital for ongoing care on day 17. Bowel obstruction is an uncommon complication in the perinatal period in infants with CDH. A high index of suspicion for bowel compromise is needed in neonates who deteriorate acutely after a period of stabilization. Imaging should be obtained as soon as possible and early surgical intervention may be life-saving.
Collapse
Affiliation(s)
- E Tian Tan
- Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | - Keren Sloan
- Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland
| | - Kokila Lakhoo
- Department of Paediatric Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom of Great Britain and Northern Ireland.,Department of Paediatric Surgery, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
7
|
Musikatavorn K, Saoraya J. Young Woman With Epigastric Pain. Ann Emerg Med 2017; 69:e25-e26. [DOI: 10.1016/j.annemergmed.2016.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Indexed: 11/29/2022]
|
8
|
The Cause of Unexpected Acute Abdomen and Intra-Abdominal Hemorrhage in 24-Week Pregnant Woman: Bochdalek Hernia. Case Rep Surg 2016; 2016:6591714. [PMID: 28018700 PMCID: PMC5149612 DOI: 10.1155/2016/6591714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022] Open
Abstract
Bochdalek hernia (BH) is the most common type of congenital diaphragm hernia and is rarely seen in adults. In adult patients, BH often remains asymptomatic or presents with nondiagnostic symptoms and may lead to complications, though rarely. The necrosis and perforations occurring in the hernia may lead to mortality. In this report, we present a 34-year-old pregnant woman at 24 gestational weeks who presented with Bochdalek hernia causing gastric volvulus associated with perforation and intra-abdominal hemorrhage associated with splenic rupture.
Collapse
|
9
|
Bandré E, Wandaogo A, Ouedraogo I, Napon M, Béré B, Kabré Y, Lamita Tapsoba TW, Ouédraogo FS. Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso). Afr J Paediatr Surg 2015; 12:79-81. [PMID: 25659558 PMCID: PMC4955490 DOI: 10.4103/0189-6725.150991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.
Collapse
Affiliation(s)
- Emile Bandré
- Department of Paediatric Surgery, Charles de Gaulle Paediatric Teaching Hospital 01, PO Box 1198, Ouagadougou 01, Burkina Faso
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Ng J, Rex D, Sudhakaran N, Okoye B, Mukhtar Z. Tension gastrothorax in children: introducing a management algorithm. J Pediatr Surg 2013; 48:1613-7. [PMID: 23895982 DOI: 10.1016/j.jpedsurg.2013.05.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 11/26/2022]
Abstract
Tension gastrothorax is a life-threatening condition and presents dramatically. It develops when the stomach herniates through a diaphragmatic defect into the thorax and distends with gas and/or fluid causing mediastinal shift. It is commonly misdiagnosed as tension pneumothorax which results in significant morbidity and mortality. In this article we report our experience of three cases with a spectrum of aetiology and a comprehensive literature review of tension gastrothorax in children. We propose an algorithm for the management of tension gastrothorax.
Collapse
Affiliation(s)
- Jessica Ng
- Core Surgical Trainee, London Deanery, London, UK
| | | | | | | | | |
Collapse
|