scholarly journals Congenital Diaphragmatic Hernia: Review of Current Concept in Surgical Management

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Emeka B. Kesieme ◽  
Chinenye N. Kesieme
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Surgical Management ◽  
Diaphragmatic Hernia ◽  
Minimal Invasive Surgery ◽  
Pulmonary Hypoplasia ◽  
Open Repair ◽  
Minimal Invasive ◽  
Fetal Intervention ◽  
Prosthetic Devices ◽  
Diaphragmatic Hernias

Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.

scholarly journals Outcome of management of congenital diaphragmatic hernia

2015 ◽  
Vol 47 (1-2) ◽  
pp. 12-15
Author(s):  
Amar Kumar Saha ◽  
Md Barkat Ali ◽  
Sunil Kumar Biswas
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Minimal Invasive Surgery ◽  
Open Repair ◽  
Antenatal Diagnosis ◽  
Important Determinant ◽  
Minimal Invasive ◽  
Surgical Correction ◽  
Set Up ◽  
Series Report

Congenital Diaphragmatic Hernia (CDH) is a defect in the dome of diaphragm, more often in left and postero-lateral that permits the herniation of abdominal contents into the thorax. The lungs hypoplasia, pulmonary hypertension and persistent foetal circulation are important determinant of survival. The incidence is <5 in 10,000 live-births. Antenatal diagnosis is ofen made and this may be helpful in postnatal management. Treatment after birth requires all the refinements of critical care prior to surgical correction. The best hospital series report 80-100% survival. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, improved prenatal diagnosis, introduction of minimal invasive surgery and application of extracorporeal membrane oxygenation in addition to the standard open repair. In our short series survival was 100% where surgical correction was made on selective 12 cases of left sided CDH in a non-ICU set-up. DOI: http://dx.doi.org/10.3329/bmjk.v47i1-2.22556 Bang Med J (Khulna) 2014; 47 : 12-15

Lung Pathology in Patients with Congenital Diaphragmatic Hernia Treated with Fetal Surgical Intervention, Including Tracheal Occlusion

2003 ◽  
Vol 6 (6) ◽  
pp. 536-546 ◽  
Author(s):  
Amy E. Heerema ◽  
Joseph T. Rabban ◽  
Roman M. Sydorak ◽  
Micheal R. Harrison ◽  
Kirk D. Jones
Keyword(s):  
Body Weight ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Pulmonary Hypoplasia ◽  
Weight Ratio ◽  
Lung Pathology ◽  
Body Weight Ratio ◽  
Fetal Intervention ◽  
Tracheal Occlusion ◽  
Significant Difference

Fetal intervention for congenital diaphragmatic hernia was developed to lessen the high morbidity and mortality of pulmonary hypoplasia. Lung pathology and morphometry in patients treated with fetal intervention have not been described. We report clinical and autopsy findings, as well as basic lung morphometry in 16 cases of congenital diaphragmatic hernia with fetal intervention (12 cases tracheal occlusion; 4 cases hernia repair), and 19 cases of congenital diaphragmatic hernia without fetal intervention. All patients who underwent fetal intervention were born premature. Lung enlargement with increased lung-to-body weight ratio was observed with fetal tracheal occlusion, accompanied by lower than normal radial alveolar counts and increased alveolar size. Patients treated with tracheal occlusion also had early alveolar development (at 29.8, 30.6, and 30.9 wk postconceptual age) as well as mucous fluid pooling in airways and alveoli. All cases showed severe alveolar septal widening, more extensive in patients without fetal intervention. When grouped by postconceptual age, no statistically significant difference was found between patients with and without fetal intervention with respect to lung-to-body weight ratio, radial alveolar count, mean alveolar length, and relative arteriolar media thickness. Lung enlargement has been observed with fetal tracheal occlusion sonographically; our studies suggest that this is due in part to emphysema and mucous fluid pooling. The lung remains abnormal with low radial alveolar counts and increased alveolar size. Tracheal occlusion did not prevent development of lung pathology associated with pulmonary hypoplasia.

A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia

2016 ◽  
Vol 2 (4) ◽  
pp. 65-67
Author(s):  
R Nagesh ◽  
Anil K Shukla ◽  
Sonam Sanjay ◽  
VV Seetha Pramila
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Rare Case ◽  
Pulmonary Hypoplasia ◽  
Adult Population ◽  
Clinical Problem ◽  
Late Presentation ◽  
The Right ◽  
Major Clinical Problem ◽  
Diaphragmatic Hernias

ABSTRACT Congenital diaphragmatic hernia is a well-described condition that occurs in about 1 in 5,000 live births. A majority of the patients are diagnosed either antenatal or will present in the first few hours of life with respiratory distress. Presentation in adults is extremely rare and accounts for about 5 to 25% of diaphragmatic hernias. Patients, who present with late diaphragmatic hernias, complain of a wide variety of symptoms and diagnosis can be difficult. It consists of herniation of bowel, and occasionally solid organs, into the chest. It is more common on the left side (seen in 80% of cases), as the liver provides a relative barrier on the right side. The major clinical problem is pulmonary hypoplasia, a result of the lung having failed to develop in utero as the thoracic cavity is filled with abdominal contents. These congenital diaphragmatic defects have also been described in the adult population, and the widespread use of computed tomography has led to the recognition that these hernias are not uncommon and are often asymptomatic. How to cite this article Sanjay S, Pramila VVS, Shukla AK, Nagesh R. A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia. J Med Sci 2016;2(4):65-67.

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Neonatology ◽  
2017 ◽  
Vol 112 (4) ◽  
pp. 365-371 ◽  
Author(s):  
Eva Van Ginderdeuren ◽  
Karel Allegaert ◽  
Herbert Decaluwe ◽  
Jan Deprest ◽  
Anne Debeer ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Fetal Intervention

scholarly journals Congenital Diaphragmatic Hernia in Neonate: Experience in a Teaching Hospital

1970 ◽  
Vol 7 (1) ◽  
pp. 28-30 ◽  
Author(s):  
SE Khan ◽  
AKMZ Siddiq ◽  
M Nessa
Keyword(s):  
Pulmonary Hypertension ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Birth Defect ◽  
Pulmonary Hypoplasia ◽  
Good Prognosis ◽  
Military Hospital ◽  
Paediatric Surgery ◽  
Stabilization Phase ◽  
Abdominal Route

Introduction: Congenital diaphragmatic hernia (CDH) is one of the major surgical causes of respiratory distress in neonates. Reported survival averages 60% but may be significantly lower. Pulmonary hypertension and pulmonary hypoplasia are recognised as two corner stones of the pathophysiology of CDH. Objective: Objective of the study was to evaluate the outcome of this birth defect in Bangladesh situation. Method: This retrospective study was carried out at the Department of Paediatric Surgery of Combined Military Hospital, Dhaka over a period of five years. During this period a total of 8 neonates of CDH were admitted in this hospital. All the data were collected from record sheet and were compiled. Result: Age of patients ranged from 1 day to 20 days. Out of 8 neonates 5 (62.50%) were male and 3 (37.50%) were female. All patients were diagnosed postnatally. All the 8 neonates had Bochdalek type of CDH. Seven patients (87.50%) had left sided hernia. Two patients (25%) died before operation in the stabilization phase while on ventilator and 6 (75%) were operated. Out of these 6 patients, 5 (left sided) were operated through abdominal route and 1 (right sided) was approached through thorax. Overall outcome was satisfactory in 5 neonates and one died. Conclusion: Early intervention can result good prognosis in CDH. Key words: Congenital diaphragmatic hernia; neonate; Bochdalek type DOI: http://dx.doi.org/10.3329/jafmc.v7i1.8623 JAFMC Bangladesh. Vol 7, No 1 (June) 2011; 28-30  

scholarly journals Amniotic fluid stem cell extracellular vesicles promote fetal lung branching and cell differentiation in experimental congenital diaphragmatic hernia

2022 ◽  
Author(s):  
Kasra Khalaj ◽  
Rebeca Lopes Figueira ◽  
Lina Antounians ◽  
Sree Gandhi ◽  
Matthew Wales ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Congenital Diaphragmatic Hernia ◽  
Extracellular Vesicles ◽  
Diaphragmatic Hernia ◽  
Lung Development ◽  
Pulmonary Hypoplasia ◽  
Fetal Lung ◽  
Branching Morphogenesis ◽  
Neuroendocrine Cells ◽  
Beta Catenin

Pulmonary hypoplasia secondary to congenital diaphragmatic hernia (CDH) is characterized by impaired branching morphogenesis and differentiation. We have previously demonstrated that administration of extracellular vesicles derived from rat amniotic fluid stem cells (AFSC-EVs) rescues development of hypoplastic lungs at the pseudoglandular and alveolar stages in rodent models of CDH. Herein, we tested whether AFSC-EVs exert their regenerative effects at the canalicular and saccular stages, as these are translationally relevant for clinical intervention. To induce fetal pulmonary hypoplasia, we gavaged rat dams with nitrofen at embryonic day 9.5 and demonstrated that nitrofen-exposed lungs had impaired branching morphogenesis, dysregulated signaling pathways relevant to lung development (FGF10/FGFR2, ROBO/SLIT, Ephrin, Neuropilin 1, beta-catenin) and impaired epithelial and mesenchymal cell marker expression at both stages. AFSC-EVs administered to nitrofen-exposed lung explants rescued airspace density and increased the expression levels of key factors responsible for branching morphogenesis. Moreover, AFSC-EVs rescued the expression of alveolar type 1 and 2 cell markers at both canalicular and saccular stages, and restored markers of club, ciliated epithelial, and pulmonary neuroendocrine cells at the saccular stage. AFSC-EV treated lungs also had restored markers of lipofibroblasts and PDGFRA+ cells to control levels at both stages. EV tracking showed uptake of AFSC-EV RNA cargo throughout the fetal lung and an mRNA-miRNA network analysis identified that several miRNAs responsible for regulating lung development processes were contained in the AFSC-EV cargo. These findings suggest that AFSC-EV based therapies hold potential for restoring fetal lung growth and maturation in babies with pulmonary hypoplasia secondary to CDH.

scholarly journals Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Jennifer M. Kim ◽  
Marisa Couluris ◽  
Bruce M. Schnapf
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Gastrointestinal Symptoms ◽  
Lower Lobe ◽  
Abdominal Radiograph ◽  
Rare Occurrence ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
Diaphragmatic Hernias ◽  
Vague Abdominal Pain

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence.

Abnormalities of the Fetal Chest

2019 ◽  
Author(s):  
Karen M. Davidson
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Airway Obstruction ◽  
Diaphragmatic Hernia ◽  
Pulmonary Hypoplasia ◽  
Abnormal Development ◽  
Neurenteric Cyst ◽  
Congenital Pulmonary Airway Malformation ◽  
Bronchopulmonary Sequestration ◽  
Lung Agenesis ◽  
Pulmonary Airway

The normal and abnormal development of the organs lying within the fetal thorax is discussed.  The abnormalities reviewed include more common findings of pulmonary hypoplasia, congenital diaphragmatic hernia, congenital pulmonary airway malformation, bronchopulmonary sequestration, as well as the rarer conditions of congenital fetal hydrothorax, congenital high airway obstruction syndrome, bronchogenic cysts, neurenteric cysts, and lung agenesis.  With each abnormality, the clinical implications for the fetus, best methods for prenatal diagnosis, as well as possible additional anomalies, syndromes, and aneuploidies are described.  In utero and postnatal treatments are also reviewed.   This review contains 10 figures, and 37 references. Key Words: Pulmonary hypoplasia, lung-head ratio, congenital diaphragmatic hernia, congenital pulmonary airway malformation, congenital fetal hydrothorax, bronchopulmonary sequestration, congenital high airway obstruction syndrome, bronchogenic cyst, neurenteric cyst, lung agenesis

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