Later Age Diaphragmatic Hernia

Czech version

Authors: M. Fuňáková; V. Cingel; J. Trnka; J. Babala; M. Babulic; J. Hornová ^*; F. Horn
Authors‘ workplace: Klinika detskej chirurgie LF UKo a DFNsP, Bratislava, Slovenská republika, prednosta: MUDr. J. Trnka, CSc. ; I. detská klinika LF UKo a DFNsP, Bratislava, Slovenská republika, prednostka: doc. MUDr. O. Červeňová, CSc. ^*
Published in: Rozhl. Chir., 2008, roč. 87, č. 10, s. 554-558.
Category: Monothematic special - Original

Overview

Introduction:
Congenital diaphragmatic hernia (CDH) is usually diagnosed antenatally or through the neonatal period at present. It is also used to treat and manage CDH in this date. However in rare cases CDH could be presented after finished neonatal period with non-specific and misleading symptoms. The aim of our presentation is to analyze the patients with late – presenting and diagnosed CDH.

Methods:
During period 1996–2006 we operated on 54 children with CDH, 12 of them with late – presenting CDH, age variance was 9 months and 6 years. The spectrum of symptoms was from asymptomatic CDH (2 patients), mild respiratory (4 patients) and gastrointestinal symptoms (4 patients), combination of respiratory and gastrointestinal symptoms (2 patients) and finally the symptomatology of bowel incarceration (2 patients).

Results:
Seven children presented with another associated malformations (m. Down, congenital heart failure, hydrocephalus, anorectal atresia). All 12 patients were operated on with a good results. The operation was composed of reposition of the herniated part of gastrointestinal tract (without need of resection) and diaphragmatic plastic. Two patients were reoperated on – once because of diaphragmatic relaxation and the second one due to consecutive heart operation.

Conclusion:
Congenital diaphragmatic hernia could be presented with chronic and non-specific respiratory or gastrointestinal symptoms. Time to time, presentation of diaphragmatic hernia as “acute abdomen” could be seen. The operation is indicated, also in asymptomatic patients as a prevention of life-threating events.

Key words:
congenital diaphragmatic hernia – hernia of Bochdaleki – Morgani hernia – late clinical manifestation

Sources

1. Alper, B., Vargun, R., Kologlu, M. B., Fitoz, S., Suskan, E., Dindar, H. Late presentation of a traumatic rupture of the diaphragm with gastric volvulus in a child: report of a case. Surg. Today, 2007, 37 (10), p. 874–877.

2. Al-Salem, A. H. Congenital hernia of Morgagni in infants and children. J. Pediatr. Surg., 2007, 42, p. 1539–1543.

3. Baglaj, M. Late-presenting congenital diaphragmatic hernia in children: A clinical spectrum. Pediatr. Surg. Int., 2004, 20, p. 658–669.

4. Blackstone, M. M., Mistry, R. D. Late-presenting congenital diaphragmatic hernia mimicking bronchiolitis. Pediatr. Emerg. Care, 2007, Sep, 23 (9), p. 653–656.

5. Cigdem, M. K., Onen, A., Okur, H., Otcu, S. Associated malformations in Morgagni hernia. Pediatr. Surg. Int., 2007, Nov, 23 (11), p. 1101–1103.

6. Cigdem, M. K., Onen, A., Otcu, S., Okur, H. Late presentation of Bochdalek-type congenital diaphragmatic hernia in children: a 23-year experience at a single center. Surg. Today, 2007, 37(8), p. 642–645.

7. Daher,P., Zeidan, S., Azar, E., Khoury, M., Melki, I., Mikhael, R. Right congenital diaphragmatic hernia a well-known pathology. Pediatr. Surg. Int., 2003, 19, p. 293–295.

8. Deprest, J., Jani, J., Lewi, L., Ochsenbein-Kolble, N., Cannie, M., Doné, E., Roubliova, X., van Mieghem, T. Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation. Semin. Fetal Neonatal. Med., 2006, Dec; 11(6): 398–412. E pub 2006 Oct 20

9. Drahovský, P., Dankovčík, J., Bodnárová, A., Drahovská, I., Sabovčík, R. Vrodená bráničná hernia prejavujúca sa po novorodeneckom období. Rozhl. Chir., 1999, roč. 78, č. 3, s. 123–126.

10. Endo, S:, Tsubochi, H., Nakano, T., Koyama, S:, Sohara, Y. Chronic diaphragmatic hernia. Gen. Thorac. Cardiovasc. Surg., 2007 Aug, 55 (8), p. 328–330.

11. Gangopadhyay, A. N., Vijai, D. U., Gupta, D. K., Sharma, S. P. Obstructed Morgagni‘s Hernia. Indian J. Pediatr, 2007, 74 (12), p. 1109–1110.

12. Gucciardo, L., Deprest, J., Done, E., van Mieghem, T., van de Velde, M., Gratacos, E., Jani, J., Peralta, F., Nicolaides, K. Prediction of outcome in isolated congenital diaphragmatic hernia and its consequenses for fetal therapy. Best Pract. Res. Clin. Obstet Gynaecol., 2008 Feb; 22 (1): 123–138. E pub 2007 Dec 21.

13. Parmar, R. C., Tullu, M. S., Bavdekar, S. B., Borwankar, S. S. Morgagni hernia with Down syndrome: a rare association- case report and review of literature. J. Postgrad. Med., 2001, 47, p. 188.

14. Rajaram, B. V., Srikrishna, S. V. Morgagni‘s hernia: An unusual presentation. Indian J. Surg., 2005, 67, p. 222–223.

15. Rygl, M., Pýcha, K., Zeman, L., Škába, R., Šnajdauf, J., Kynčl, M. Pozdní manifestace vrozené brániční kýly. Rozhl. Chir., 2003, roč. 82, č. 12, s. 616–619.

16. Sakalkale, R. P., Sankhe, M., Nagral, S., Patel, C. V. Obstructed Morgagni‘s Hernia (a case report). J. Postgrad. Med., 2008, Mar 18, 37, p. 228.

17. Vyhnánek, M., Rygl, M., Šnajdauf, J., Škába, R., Kynčl, M. Morgagniho brániční kýly v dětském věku. Rozhl. Chir., 2006. roč. 85, č. 10, s. 494–497.

18. Drahovský P., Šudák M., Krcho P., Deprest J., Drahovská I. FETO intervencia pri vrodenej bráničnej hernii. [on line].

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