1
|
Shaker K, Alomar K, Chouman Y, Rastanawi A, Alkader MA, Eid N. A unique case of hepatopulmonary fusion in congenital diaphragmatic hernia causing pulmonary hypoplasia in a newborn: A case report study. Int J Surg Case Rep 2024; 124:110331. [PMID: 39326375 DOI: 10.1016/j.ijscr.2024.110331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/16/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Hepatopulmonary fusion is a rare congenital malformation associated with right-sided diaphragmatic hernia. Often diagnosed during surgery, it carries a high mortality rate. CASE PRESENTATION We present a case of a full-term infant who exhibited shortness of breath from birth. Radiological examinations confirmed a right congenital diaphragmatic hernia, and subsequent surgery revealed hepatopulmonary fusion. CLINICAL DISCUSSION While hepatopulmonary fusion is uncommon, it should be considered in the differential diagnosis of right-sided congenital diaphragmatic hernia (CDH). Preoperative evaluation for vascular malformations and meticulous surgical planning are essential. CONCLUSION Managing hepatopulmonary fusion poses significant challenges for surgeons. Its association with pulmonary malformations increases surgical complexity, risk, and adversely impacts prognosis, as exemplified in our case.
Collapse
Affiliation(s)
- Kamar Shaker
- Damascus University, University pediatrics' Hospital, Damascus, Syria.
| | - Khaled Alomar
- Damascus University, University pediatrics' Hospital, Damascus, Syria.
| | - Youssef Chouman
- Damascus University, University pediatrics' Hospital, Damascus, Syria
| | - Alhasan Rastanawi
- Damascus University, University pediatrics' Hospital, Damascus, Syria
| | | | - Nader Eid
- Damascus University, University pediatrics' Hospital, Damascus, Syria.
| |
Collapse
|
2
|
Menon R, Saxena R, Pathak M, Yadav T. Hepatopulmonary fusion in congenital diaphragmatic hernia: successful management of a lethal variant. BMJ Case Rep 2024; 17:e260486. [PMID: 38926130 DOI: 10.1136/bcr-2024-260486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a congenital anomaly involving the herniation of intra-abdominal contents into the thoracic cavity. Hepatopulmonary fusion (HPF), an exceedingly rare subtype mainly associated with right-sided CDH, presents unique diagnostic and therapeutic challenges. This case report describes a male infant with right-sided CDH complicated by HPF. The intricate anatomical anomaly involved the fusion of the right lung to the liver, posing challenges during surgical separation. The patient experienced postoperative complications, including prolonged ventilation, tracheostomy and pulmonary issues, which led to a prolonged hospital stay. Intraoperative challenges stem from the absence of demarcation between lung and liver tissues and abnormal vascular structures. In summary, managing HPF in right-sided CDH necessitates a customised, multidisciplinary approach to optimise patient outcomes, highlighting the need for ongoing research to refine understanding and treatment strategies.
Collapse
Affiliation(s)
- Revathy Menon
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| |
Collapse
|
3
|
Alomar K, Alghazal LK, Alloun M, Dawarah M, Alkhayer G, Alkader MA. A rare case of hepatopulmonary fusion associated with a right congenital diaphragmatic hernia: Case report and review of the literature. Int J Surg Case Rep 2023; 111:108845. [PMID: 37741077 PMCID: PMC10520523 DOI: 10.1016/j.ijscr.2023.108845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Hepatic-pulmonary fusion is a very rare condition that occurs in the right congenital diaphragmatic hernia and appears to affect both sexes equally. There are no specific diagnostic methods before surgery for this anomaly. Most cases are discovered during surgical repair of the right congenital diaphragmatic hernia. This anomaly is considered to have a poor prognosis because of the associated vascular abnormalities and pulmonary hypoplasia. CASE PRESENTATION We present the case of a neonate who suffered from respiratory distress since birth. Later, a congenital right diaphragmatic hernia was diagnosed. At surgery, it was found that hepatic-pulmonary fusion was present, accompanied by an anomaly of pulmonary venous outflow. A complete detachment of the connective tissue was performed and a patch was placed to close the defect in the diaphragm. CLINICAL DISCUSSION The few cases of hepatic pulmonary fusion reported in the medical literature make it difficult to develop a clear plan for diagnosis and surgical management. However, this anomaly should be considered when right-sided congenital diaphragmatic hernia is present, and the case should be well investigated and the surgical decision should not be rushed. CONCLUSION Hepatic-pulmonary fusion has a poor prognosis and a high mortality rate. No pathological mechanism for this anomaly has been identified, so we could not identify a specific diagnostic mechanism or a specific surgical method to treat this anomaly.
Collapse
Affiliation(s)
- Khaled Alomar
- Damascus University - University pediatrics' Hospital, Syria.
| | | | - Maher Alloun
- Damascus University - University pediatrics' Hospital, Syria
| | - Methad Dawarah
- Damascus University - University pediatrics' Hospital, Syria
| | | | | |
Collapse
|
4
|
Franco MA, Alzate-Ricaurte S, Alzate Gallego ED, Kafury DF, Botero ALG, Avila DC. Survival after a two-stage surgical approach in hepatopulmonary fusion: A case report. Int J Surg Case Rep 2023; 108:108467. [PMID: 37423148 PMCID: PMC10382799 DOI: 10.1016/j.ijscr.2023.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION Congenital diaphragmatic hernias are a rare developmental defect. Pulmonary complications are more frequently seen in right sided defects (Partridge et al., 2016). Hepatopulmonary fusion is a rare and highly mortal malformation exclusively seen in right sided congenital diaphragmatic hernias marked by the fibrovascular fusion of the liver and lung. PRESENTATION OF CASE A newborn male presented with respiratory distress and a 1-minute APGAR score of 7. A chest radiograph showed complete opacification of the right hemithorax, and a CT-Scan confirmed a congenital diaphragmatic hernia, an intrathoracic location of the liver and secondary pulmonary hypoplasia. 48 h after, intraoperative findings showed fusion of diaphragm, lung and liver tissue. Four months after, complete tissue division of the lower lobe from the fused liver segments VII/VIII and correction of the hernia defect was achieved. The patient was discharged from the hospital six months after. DISCUSSION Partial division of tissues is described as the safest and most successful approach to hepatopulmonary fusion. The tally of all cases reported worldwide until 2020 shows higher survival rates with complete division of tissues (Ferguson DM; Congenital Diaphragmatic Hernia Study Group, 2020) Reported cases lean towards one-session surgical interventions. A two-stage surgical approach allows an initial low surgical trauma to manage compressive effects on intrathoracic structures by herniary contents and a second time for tissue division in a non-critical patient, in this case leading to long-term survival. CONCLUSION Hepatopulmonary fusion is a rare and highly lethal malformation with scarce information available. Future multicenter studies should compare different therapeutic options and search for outcomes including but not limited to mortality.
Collapse
Affiliation(s)
- Maudy Aguilar Franco
- Fundación Valle del Lili, Department of Pediatric Surgery, Cra 98 Num. 18-49, Cali 760032, Colombia; Universidad ICESI, School of medicine, Cali, Colombia
| | - Sergio Alzate-Ricaurte
- Fundación Valle del Lili, Department of Pediatric Surgery, Cra 98 Num. 18-49, Cali 760032, Colombia; Fundación Valle del Lili, Centro de Investigaciones Clinicas, Cra 98 Num. 18-49, Cali 760032, Colombia.
| | - Edgar Dario Alzate Gallego
- Fundación Valle del Lili, Department of Pediatric Surgery, Cra 98 Num. 18-49, Cali 760032, Colombia; Universidad ICESI, School of medicine, Cali, Colombia
| | | | | | - Daniela Castaño Avila
- Fundación Valle del Lili, Department of Pediatric Surgery, Cra 98 Num. 18-49, Cali 760032, Colombia
| |
Collapse
|
5
|
Rocha GMD. Congenital Hepatopulmonary Fusion. Eur J Pediatr Surg 2022; 32:477-496. [PMID: 36027900 DOI: 10.1055/s-0042-1749213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Congenital hepatopulmonary fusion (HPF) is a rare anomaly characterized by a fusion between the liver and lung parenchyma. HPF cases have been scarcely reported in the literature. An extensive search of publications was performed in the PubMed and Google Scholar databases without a time limit. In total, 34 clinical case reports were found in the literature, and a study by the Congenital Diaphragmatic Hernia (CDH) Study Group reported data on 10 patients with HPF. Of these 44 infants, 20 were male, 20 were female, and four were reported without gender specification. Nineteen (43.2%) patients required intubation on the first day of life. Six (13.6%) patients had their clinical presentation during the first year of life, and four (9%) clinically presented with HPF between 2.5 and 11 years of age. In these patients, cough, asthma-like symptoms, dyspnea, hemoptysis, right-side chest pain, respiratory infections, and pneumonia were the relevant clinical signs. Right-lung vascular anomalies were present in 18 (40.9%) patients. A complete liver and lung separation was successful in 17 (38.6%) patients. The overall survival was 56.8%. Congenital HPF has no gender predominance. In most cases, it behaves similar to a right CDH in need of resuscitation and intubation after birth. The majority of the cases are discovered during the surgical procedure for CDH. The best surgical approach has not been established and depends on the degree of fusion and vascular anomalies. An advanced imaging assessment is necessary before a surgical approach is attempted. The prognosis is ominous.
Collapse
Affiliation(s)
- Gustavo M D Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| |
Collapse
|
6
|
Al-Zaiem M, Raml EI, Alsulaimani N, Alzahrani L, alzahrani A, Turki A. Right congenital diaphragmatic hernia associated with hepatic pulmonary fusion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
7
|
Pikturnaitė G, Račytė A, Dagilytė RV, Strumila A, Verkauskas G. Associated intraabdominal malformations of right-sided congenital diaphragmatic hernia: A rare anomaly and review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
8
|
A Strangulated Congenital Diaphragmatic Bochdalek Hernia Diagnosed in an Adult. Case Rep Med 2022; 2022:3355058. [PMID: 35909918 PMCID: PMC9328991 DOI: 10.1155/2022/3355058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/19/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Although Bochdalek hernias are uncommon in adults and difficult to diagnose, such congenital diaphragmatic hernias (CDHs) are some of the most serious malformations among newborns. In particular, CDHs are accompanied by high mortality and marked disability later in life due to concomitant morbidity (i.e., caused by pulmonary lung hypoplasia and persisting pulmonary hypertension of neonates) and require long-lasting neonatal treatment in an intensive care unit. Late-diagnosed CDHs are extremely rare and always show small defects that justify a better prognosis than CDHs with large defects. In most cases, such CDHs go undiagnosed due to their mild, delayed symptoms. In the case described here, an 18-year-old Asian male presented with abdominal pain and a bowel contour in the epigastric region and left upper quadrant. A chest X-ray and thoracoabdominal computerized tomography scan confirmed the diagnosis of bowel obstruction due to a left diaphragmatic hernia. Moreover, a defect was revealed in the posterolateral left diaphragm, and the transverse colon, spleen, and half of the stomach had herniated through it. A segmentectomy was performed on the transverse colon, followed by an end-to-end anastomosis, a diaphragmatic plasty, and the placement of an intrapleural catheter. In conclusion, diagnosing a diaphragmatic hernia before surgery can be difficult due to its rarity and wide range of symptoms. Although prenatal diagnosis using ultrasonography is possible in up to 80% of fetuses, that method may not be available in all regions in Indonesia or in all countries, where doctors thus continue to face a diagnostic challenge when dealing with CDHs.
Collapse
|
9
|
Saleem A, Alnaqi AA, Taqi EA. Right-sided congenital diaphragmatic hernia associated with hepatopulmonary fusion and congenital pulmonary malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
10
|
Right-Sided Congenital Diaphragmatic Hernia Caused by Hepatopulmonary Fusion. Case Rep Pediatr 2020; 2020:8851341. [PMID: 33178472 PMCID: PMC7644339 DOI: 10.1155/2020/8851341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Hepatopulmonary fusion is a very rare finding associated with right-sided congenital diaphragmatic hernia. With less than 50 reported cases, management and outcomes of hepatopulmonary fusion are poorly understood. This report highlights that clinical presentation is not a reliable indicator of outcomes in this rare disease. Case Presentation. A term neonate admitted for tachypnea and complete opacification of the right hemithorax was diagnosed with right-sided congenital diaphragmatic hernia. Preoperative respiratory support was minimal, and the only symptom exhibited was tachypnea. During surgical repair, fusion of the lung and liver were noted, consistent with a diagnosis of hepatopulmonary fusion. Postoperatively, the patient's pulmonary hypertension worsened and required extracorporeal membrane oxygenation. Conclusions Many patients with hepatopulmonary fusion and only mild symptoms die postoperatively from severe pulmonary hypertension and progressive respiratory failure. Preoperative clinical status is not indicative of postoperative outcomes, and literature suggests that patients who require less support preoperatively have high mortality rates. The availability of ECMO for postoperative complications may be necessary in patients requiring repair of hepatopulmonary fusion.
Collapse
|
11
|
Impacts of Respiratory Muscle Training on Respiratory Functions, Maximal Exercise Capacity, Functional Performance, and Quality of Life in School-Aged Children with Postoperative Congenital Diaphragmatic Hernia. DISEASE MARKERS 2020; 2020:8829373. [PMID: 32963638 PMCID: PMC7492875 DOI: 10.1155/2020/8829373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022]
Abstract
Objectives Congenital diaphragmatic hernia (CDH) is a birth defect affecting the respiratory functions, functional performance, and quality of life (QOL) in school-aged children. Rarely have studies been conducted to evaluate the impacts of respiratory muscle training on school-aged children with postoperative CDH. The current study was designed to evaluate the impacts of respiratory muscle training on respiratory function, maximal exercise capacity, functional performance, and QOL in these children. Methods This study is a randomized control study. 40 children with CDH (age: 9-11 years) were assigned randomly into two groups. The first group conducted an incentive spirometer exercise combined with inspiratory muscle training (study group, n = 20), whereas the second group conducted only incentive spirometer exercise (control group, n = 20), thrice weekly for twelve consecutive weeks. Respiratory functions, maximal exercise capacity, functional performance, and pediatric quality of life inventory (PedsQL) were assessed before and after the treatment program. Results. Regarding the posttreatment analysis, the study group showed significant improvements in all outcome measures (FVC%, p < 0.001; FEV1%, p = 0.002; VO2max, p = 0.008; VE/VCO2 slope, p = 0.002; 6-MWT, p < 0.001; and PedsQL, p < 0.001), whereas the control group did not show significant changes (p > 0.05). Conclusion Respiratory muscle training may improve respiratory functions, maximal exercise capacities, functional performance, and QOL in children with postoperative CDH. Clinical commendations have to be considered to include respiratory muscle training in pulmonary rehabilitation programs in children with a history of CDH.
Collapse
|
12
|
Hepatopulmonary fusion: A rare variant of congenital diaphragmatic hernia. J Pediatr Surg 2020; 55:1903-1907. [PMID: 31708208 DOI: 10.1016/j.jpedsurg.2019.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hepatopulmonary fusion (HPF), a rare anomaly associated with right congenital diaphragmatic hernia (CDH), is characterized by a fibrovascular fusion between herniated liver and lung parenchyma. We aimed to clarify patient characteristics, management strategies, and outcomes in HPF. METHODS Data on infants with HPF were obtained from the Congenital Diaphragmatic Hernia Registry (CDHR). Patient characteristics, management, and outcomes were compared with the results of a literature review. RESULTS Ten cases of HPF were identified in the CDHR. Five patients survived. The median estimated gestational age was 38 weeks (range 36-40). Median birth weight was 2.7 kg (range 2.0-3.8 kg), but non-survivors had a lower median birth weight (2.3 kg vs. 3.5 kg). All patients had at least 1 congenital anomaly in addition to CDH. Operative approach varied, but most surgeons performed only partial separation of the liver and lung (n = 6). The 2 patients who underwent complete separation both ultimately died, 1 due to significant postoperative complications and 1 due to severe pulmonary hypertension with multiple vascular anomalies. CONCLUSION Partial separation of liver and lung appears to be the wisest surgical approach in HPF, as complete separation has resulted in catastrophic complications due to frequent underlying vascular anomalies. LEVEL OF EVIDENCE IV.
Collapse
|
13
|
Kerkeni Y, Farhani R, Sassi N, Hamzaoui M. How to treat hepatic pulmonary fusion: case report with review of literature. Acta Chir Belg 2020; 120:50-52. [PMID: 30203718 DOI: 10.1080/00015458.2018.1496568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Hepatic pulmonary fusion (HPF) occurring with right diaphragmatic hernia is rare. Some sporadic reports exist in the literature. It may range from just fibrovascular communication to complete parenchymal fusion which may be complex to divide.Patients and methods: We report a case of a 1-day old newborn male presented with respiratory distress relevant to a right diaphragmatic hernia.Results: The patient was operated after initial stabilization. During surgery, a 10-cm wide posterolateral defect was found. The herniated liver was only partially reducible because of HPF. This rare condition was treated by the division of the fusion and diaphragm repair using a vicryl patch.Conclusion: Through our case and a review of the literature, we will discuss the different alternatives in the treatment of HPF.
Collapse
Affiliation(s)
- Yosra Kerkeni
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Université de Tunis El Manar Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Rabeb Farhani
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Université de Tunis El Manar Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Nizar Sassi
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Université de Tunis El Manar Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Mourad Hamzaoui
- Department of Pediatric Surgery "A", Children Hospital "Bechir Hamza" of Tunis, Université de Tunis El Manar Faculté de Médecine de Tunis, Tunis, Tunisia
| |
Collapse
|
14
|
Bawazir OA. Surgical repair of bilateral congenital diaphragmatic hernia associated with hepatopulmonary fusion. Saudi Med J 2019; 40:949-953. [PMID: 31522224 PMCID: PMC6790493 DOI: 10.15537/smj.2019.9.24378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bilateral congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with high neonatal mortality. The condition is rarely associated with hepatopulmonary fusion (HPF). We reported the surgical repair of bilateral CDH in a male infant aged 6 weeks. The patient had herniation of the liver on the right side with HPF in association with anomalous drainage of the right pulmonary vein into the hepatic vein and ventricular septal defect. We approached both sides thoracoscopically; however, the right side required a subcostal incision. We separated the liver from the right lower lung lobe laterally using electrocautery, and the defect was closed with a mesh. The medial portion was left intact to avoid injury of the anomalous pulmonary venous drainage. After 2 weeks, the patients had a surgical repair of the cardiac defects, and the postoperative course was complicated by bleeding and prolonged ventilation. No hernia recurrence was observed after 9 months.
Collapse
Affiliation(s)
- Osama A Bawazir
- Department of Surgery, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
15
|
Almaramhy HH. Hepatopulmonary fusion associated with right-sided congenital diaphragmatic hernia: management of this rare anomaly and a review of the literature. J Int Med Res 2018; 46:5278-5284. [PMID: 30352531 PMCID: PMC6300937 DOI: 10.1177/0300060518759892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hepatopulmonary fusion is a rare malformation that is often discovered during operative repair of right-sided congenital diaphragmatic defects. Based on a search using medical search engines, we only found 22 cases of hepatopulmonary fusion in the English literature worldwide to date. We describe herein a case of hepatopulmonary fusion with right-sided congenital diaphragmatic hernia in a female neonate who presented with respiratory distress. We discuss management of this case and review the relevant literature.
Collapse
Affiliation(s)
- Hamdi H Almaramhy
- Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| |
Collapse
|
16
|
Jain V, Yadav DK, Kandasamy D, Gupta DK. Hepatopulmonary fusion: a rare and potentially lethal association with right congenital diaphragmatic hernia. BMJ Case Rep 2017; 2017:bcr-2016-218227. [PMID: 28196822 DOI: 10.1136/bcr-2016-218227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hepatopulmonary fusion is an extremely rare accompaniment of right congenital diaphragmatic hernia. It is associated with abnormal systemic arterial supply and venous drainage of the right lung along with congenital heart disease. Children with this condition have a comparatively poor prognosis. We report a case of right congenital diaphragmatic hernia with hepatopulmonary fusion along with review of the literature with stress on diagnosis and management.
Collapse
Affiliation(s)
- Vishesh Jain
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Devendra Kumar Gupta
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
17
|
Abstract
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options. Nevertheless, short and long-term complications following neonatal surgery continue to have profound and sometimes lasting effects on individual patients, families, and society.
Collapse
Affiliation(s)
- Mauricio A Escobar
- Pediatric Surgery, Mary Bridge Children׳s Hospital, PO Box 5299, MS: 311-W3-SUR, 311 South, Tacoma, Washington 98415-0299.
| | - Michael G Caty
- Section of Pediatric Surgery, Department of Surgery, Yale-New Haven Children׳s Hospital, New Haven, Connecticut
| |
Collapse
|
18
|
Congenital Diaphragmatic Hernia with Delayed Presentation. Case Rep Surg 2016; 2016:7284914. [PMID: 27872786 PMCID: PMC5107232 DOI: 10.1155/2016/7284914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/05/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is caused due to abnormal formation of the muscular parts of diaphragm. The incidence of CDH in common births ranges from 1/25000 to 1/30000. Pulmonary hypoplasia and pulmonary hypertension are factors that associate with the increase of mortality and morbidity due to CDH. We presented a 68-year-old Iranian woman with abdominal pain and tenderness in right upper quadrant who was diagnosed as having CDH. The disease was detected using chest X-ray and chest and abdomen sonography and confirmed with chest and abdomen CT scan with and without oral contrast. A defect was revealed in posterolateral right diaphragm with omentum and transverse colon herniated through it. Right posterolateral thoracotomy was performed to cure the disease. CT and CXR were the two useful methods in diagnosis of CDH in this patient, although CDH detection prior to surgery is too challenging because of rare cases and different types of CDH. In order to improve clinical cares in adult CDH patients, investigating more cases and long term follow-up are recommended.
Collapse
|
19
|
Laamiri R, Belhassen S, Ksia A, Ben Salem A, Kechiche N, Mosbahi S, Sahnoun L, Mekki M, Belghith M, Nouri A. Right Congenital Diaphragmatic Hernia Associated With Hepatic Pulmonary Fusion: A Case Report. J Neonatal Surg 2016; 5:35. [PMID: 27433453 PMCID: PMC4942435 DOI: 10.21699/jns.v5i3.370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/22/2016] [Indexed: 11/11/2022] Open
Abstract
We present a case of male newborn presented with respiratory distress at 21 hours of life. The patient was operated for right congenital diaphragmatic hernia (CDH). Hepatic pulmonary fusion (HPF) was found at surgery.
Collapse
Affiliation(s)
- Rachida Laamiri
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Samia Belhassen
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Amine Ksia
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Amina Ben Salem
- Department of Radiology B, Maternal and Fetal Unit, Fattouma Bourguiba University Hospital-Monastir, Tunisia
| | - Nahla Kechiche
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Sana Mosbahi
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Lassaad Sahnoun
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Mongi Mekki
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Mohsen Belghith
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| | - Abdellatif Nouri
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital- Monastir, Tunisia
| |
Collapse
|