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Kelly M, Palamuthusingam P. Bochdalek herniation: an unusual cause of bowel obstruction in an adult. ANZ J Surg 2021; 91:E535-E536. [PMID: 33405301 DOI: 10.1111/ans.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Madeleine Kelly
- School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Pranavan Palamuthusingam
- Department of General Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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2
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Abstract
Congenital diaphragmatic hernia (CDH) is a rare developmental defect of the diaphragm, characterized by herniation of abdominal contents into the chest that results in varying degrees of pulmonary hypoplasia and pulmonary hypertension (PH). Significant advances in the prenatal diagnosis and identification of prognostic factors have resulted in the continued refinement of the approach to fetal therapies for CDH. Postnatally, protocolized approaches to lung-protective ventilation, nutrition, prevention of infection, and early aggressive management of PH have led to improved outcomes in infants with CDH. Advances in our understanding of the associated left ventricular (LV) hypoplasia and myocardial dysfunction in infants with severe CDH have allowed for the optimization of hemodynamics and management of PH. This article provides a comprehensive review of CDH for the anesthesiologist, focusing on the complex pathophysiology, advances in prenatal diagnosis, fetal interventions, and optimal postnatal management of CDH.
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Affiliation(s)
| | | | - Jason Gien
- Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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3
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Rare right congenital diaphragmatic hernia with ileum and colon herniated into thoracic cavity in an 18-year-old adult. Chin Med J (Engl) 2019; 132:731-732. [PMID: 30855355 PMCID: PMC6416098 DOI: 10.1097/cm9.0000000000000135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee HS, Dickinson JE, Tan JK, Nembhard W, Bower C. Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes. Prenat Diagn 2018; 38:1004-1012. [PMID: 30346634 DOI: 10.1002/pd.5376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/21/2018] [Accepted: 10/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aims to review temporal changes in perinatal management and 1-year survival outcomes of cases of congenital diaphragmatic hernia (CDH) from 1996 to 2015 in Western Australia (WA). METHOD This research is a retrospective study of all cases of CDH in WA from 1996 to 2015 identified from five independent databases within the WA health network. Detailed information pertaining to pregnancy and survival outcomes were obtained from review of maternal and infant medical records. RESULTS There were 215 cases of CDH with 164 diagnosed prenatally. Between 1996 and 2010, a decline in live birth rates for CDH-affected pregnancies was observed, reaching a nadir of 5.3 per 10 000 births before increasing to a peak of 9.73 per 10 000 births in 2011-2015. A corresponding decline was seen in the number of pregnancies terminated in the same period from 8.3 to 4.6 per 10 000 births (P = 0.14) and an increase in survival of live births from 38.9% to 81.3% (P = 0.01). CONCLUSION The improved overall survival rate in infants with CDH over the last 20 years may have resulted in an increased tendency for women to continue their pregnancy with a concomitant decline in termination rates. Information from this study will help in the counselling of women following prenatal detection of CDH.
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Affiliation(s)
| | | | - Jason Kg Tan
- Princess Margaret Hospital for Children, Perth, Australia
| | - Wendy Nembhard
- Princess Margaret Hospital for Children, Perth, Australia.,The Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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5
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Semmelmann A, Kaltofen H, Loop T. Anesthesia of thoracic surgery in children. Paediatr Anaesth 2018; 28:326-331. [PMID: 29484775 DOI: 10.1111/pan.13350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 02/06/2023]
Abstract
Providing anesthesia in children with thoracic disease is a challenging task. The effects of the underlying disease, the surgical interventions, and preexisting condition of the patient need to be considered when planning perioperative care. The perioperative care for children undergoing thoracic surgery requires specific techniques adapted to the pediatric physiology and anatomy. This review is focused on anesthetic strategies for thoracic surgery with an emphasis on perioperative analgesia including neuraxial techniques.
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Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Heike Kaltofen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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6
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Anesthesia for Congenital Diaphragmatic Hernia. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kohli N, Mitreski G, Yap CH, Leong M. Massive symptomatic right-sided Bochdalek hernia in an adult man. BMJ Case Rep 2016; 2016:bcr-2016-217432. [PMID: 27852660 DOI: 10.1136/bcr-2016-217432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.
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Affiliation(s)
- Naman Kohli
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Goran Mitreski
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Matthew Leong
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
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8
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Basani L, Aepala R, Reddy BMM. Congenital diaphragmatic hernia, Meckel's diverticulum and malrotation in a 3-month-old infant. Afr J Paediatr Surg 2016; 13:47-9. [PMID: 27251525 PMCID: PMC4955462 DOI: 10.4103/0189-6725.181708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in the neonatal period. It is known to be associated with cardiac, renal, genital and chromosomal anomalies. Late presentation of CDH (beyond 1-month of age) is seen in 13% of the cases. Malrotation is reported in 42% of CDH cases. We report a case of a 3-month-old infant with concurrent CDH, Meckel's diverticulum and malrotation. This is the first case report of such an association in an infant.
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Affiliation(s)
- Laxman Basani
- Department of Neonatology, Dolphin Children's Hospital, Hyderabad, Telangana, India
| | - Roja Aepala
- Department of Neonatology, Dolphin Children's Hospital, Hyderabad, Telangana, India
| | - B Madhu Mohan Reddy
- Department of Pediatric Surgery, Dolphin Children's Hospital, Hyderabad, Telangana, India
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Parate LH, Geetha CR, Vig S. Right sided congenital diaphragmatic hernia: A rare neonatal emergency. Saudi J Anaesth 2015; 9:227-9. [PMID: 25829924 PMCID: PMC4374241 DOI: 10.4103/1658-354x.152900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Leena Harshad Parate
- Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India
| | | | - Saurabh Vig
- Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India
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Rare case report - congenital diaphragmatic hernia presentation in adult. Indian J Surg 2014; 75:44-6. [PMID: 24426509 DOI: 10.1007/s12262-011-0321-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adults (Yamaguchi et al. Ann Thorac Cardiovasc Surg 8:106-108, 2002; Dalencourt and Katlic Ann Thorac Surg 82:721-722, 2006; Fraser et al. Endosc Percutan Tech 19: e5-e7, 2009; Kanazawa et al. Surg Today 32:812-815, 2002). These patients are been accustomed to adjust their lifestyle to manage symptoms associated with frank herniation of the large bowel and liver inside the diaphragmatic hernial sac. Bowel above the liver surface especially the transverse colon is suggestive of a Chilaiditi's syndrome in these group of patients. Diagnostic laparoscopy plays an important role for diagnosis of diaphragmatic hernia in some cases over other investigations like CT scan and ultrasonography. Chilaiditi's syndrome has no surgical line of treatment but a symptomatic diaphragmatic hernia requires surgical correction. Liver as the main hernial content has been reported only in three cases throughout the world (Goh et al. Am J Surg 194: 390-391, 2007; Luo et al. Hepatobiliary Pancreat Dis Int 6: 219-221, 2007; Bosenberg and Brown RA Curr Opin Anaesthesiol 21: 323-331, 2008). A case of a 27 year old female patient presenting with a symptomatic congenital diaphragmatic hernia is reported.
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Coleman AJ, Brozanski B, Mahmood B, Wearden PD, Potoka D, Kuch BA. First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia. J Pediatr Surg 2013; 48:2214-8. [PMID: 24210188 DOI: 10.1016/j.jpedsurg.2013.03.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO2 as predictors of ECMO support and in-hospital mortality in neonates with CDH. METHODS Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO2 within the first 24 h of NICU admission were evaluated. RESULTS Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO2, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO2 predicted mortality following multivariate adjustment. CONCLUSIONS The first 24-h SNAP-II score and highest PaCO2 may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set.
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Affiliation(s)
- Alana J Coleman
- Department of Neonatology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Michel F, Baumstarck K, Gosselin A, Le Coz P, Merrot T, Hassid S, Chaumoître K, Berbis J, Martin C, Auquier P. Health-related quality of life and its determinants in children with a congenital diaphragmatic hernia. Orphanet J Rare Dis 2013; 8:89. [PMID: 23786966 PMCID: PMC3718687 DOI: 10.1186/1750-1172-8-89] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background The development of new therapeutics has led to progress in the early management of congenital diaphragmatic hernia (CDH) in pediatric intensive care units (PICU). Little is known about the impact on the quality of life (QoL) of children and their family. The aim of this study was to assess the impact of CDH treated according to the most recent concepts and methods outlined above on child survivors’ QoL and their parents’ QoL. Patients and methods This study incorporated a cross-sectional design performed in two PICU (Marseille, France). Families of CDH survivors born between 1999 and 2008 were eligible. The following data were recorded: socio-demographics, antenatal history and delivery, initial hospitalization history. Self-reported data were collected by mail, including current clinical problems of the children (13-symptom list), children’s QoL (Kidscreen-27 questionnaire), and parents’ QoL (Short-Form 36 questionnaire). Children’s QoL score was compared with controls and QoL of survivors of childhood leukemia. Parent’s QoL was compared with controls. Non-parametric statistics were employed. Results Forty-two families agreed to participate and questionnaires were completed by 32 of them. Twenty-one children had a current clinical problems related to CDH. All the QoL scores of CHD survivors were significantly lower compared with controls. The physical well-being dimension was significantly higher for CHD survivors compared with survivors of childhood leukemia. Gastro-esophageal reflux at discharge, antenatal diagnosis, length of stay in the PICU, and neuropsychological and respiratory issues significantly impacted QoL scores of children. The parents of CHD survivors had significantly poorer score in emotional role dimension compared with controls. Conclusion The impact of CDH on QoL seems to be important and must be understood by clinicians who treat these children and their parents.
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Affiliation(s)
- Fabrice Michel
- Espace Ethique Méditerranéen, ADES UMR 7268 ADES, Espace Ethique Méditerranéen Aix-Marseille Université, Marseille 13385, France.
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Jagad RB, Kamani P. Central diaphragmatic hernia in an adult: a rare presentation. Hernia 2011; 16:607-9. [DOI: 10.1007/s10029-011-0800-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Affiliation(s)
- R B Jagad
- N M Virani Wockhardt Hospital, Kalawad Road, Rajkot, Gujarat 360007, India.
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Liu L, Xu Y, Mao Y, Sang X, Yang Z, Lu X, Zhong S, Huang J. Adult congenital diaphragmatic hernia of the liver: a rare case report. SCIENCE CHINA. LIFE SCIENCES 2010; 53:204-6. [PMID: 20596828 DOI: 10.1007/s11427-010-0022-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 10/27/2009] [Indexed: 11/25/2022]
Affiliation(s)
- LiGuo Liu
- Department of Liver Surgery, Peking Union Medical College Hospital, Beijing, 100730, China
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Wagner D, Iberer F, Sereinigg M, Kniepeiss D, Kornprat P, Fahrleitner-Pammer A, Stiegler P, Tscheliessnigg K. Massive diaphragmatic herniation following orthotopic liver transplantation in an adult. Liver Transpl 2010; 16:783-5. [PMID: 20517913 DOI: 10.1002/lt.22079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Doris Wagner
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
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