Bilateral congenital anterior diaphragmatic hernia: a case report (original) (raw)

Right sided diaphragmatic hernia of Morgagni with associated anatomical abnormalities

a rare type of diaphragmatic hernia has been observed within a cadaver in the Anatomy department during routine dissections. Normally, congenital diaphragmatic hernias appear on the left side, namely a Bochdalek hernia. This particular hernia, a Morgagni type, is uniquely found on the anterior right side of the thorax. This 101-yearold female cadaveric specimen had a herniation of the greater omentum, stomach, and portion of the duodenum into the right side of the thorax, with an associated slight mediastinal shift to the left. In addition, this cadaver had a fleshy 'string' of tissue connecting the hernia sac to the sigmoid colon, a tortuous internal carotid artery, thickened costal cartilages, and weak fascia.

Congenital Diaphragmatic Hernia Associated With Uncommon Abnormalities

International Archives of Medicine, 2017

Congenital diaphragmatic hernia is a poor formation of the diaphragm characterized by the presence of an intestinal malrotation, It is related to abnormal position of the intestine in the thorax. This case report a stillborn at 32 weeks, that was observe anatomical abnormalities associated with congenital diaphragmatic hernia, which occurred in the left antero-posterior region, such as intestinal malrotation, hepatomegaly and nephromegaly, with the presence of a hernial ring that occupied 80 % of the left side of the diaphragm, besides a hypertrophied heart, deviated to the right, bilateral pulmonary hypotrophy. This case illustrates a rare case of diaphragmatic hernia with intestinal changes of clinical and surgical importance.

Bilateral congenital diaphragmatic hernia

Pediatric Surgery International, 2005

Bilateral congenital diaphragmatic hernia (CDH) is a rare condition, with the literature suggesting a bleak prognosis. We describe a case of bilateral CDH that, despite confirming the challenges of diagnosis, demonstrates that the condition can have a favourable outcome.

Congenital asymptomatic diaphragmatic hernias in adults: a case series

Journal of Medical Case Reports, 2013

Introduction: Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. Case presentations: In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemithorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here.

Late-onset congenital diaphragmatic hernia: A case report

International Journal of Surgery Case Reports, 2013

INTRODUCTION: A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiafragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. PRESENTATION OF CASE: In this paper we present a 35 year old man with a 5-year history of episodes of severe dyspnea who arrived to the emergency room, during his medical work-up we incidentally found an intrathoracic gastric bubble, a laparoscopy was performed, founding a necrotic stomach and for defect correction. DISCUSSION: This pathology is infrequent in adults, among this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. CONCLUSION: Diaphragmatic hernias are rare among adult population, and they are usually asymptomatic, in this case we presented a symptomatic patient, diagnosed with a chest X-ray and treated surgically. The surgical approach for the resolution of this pathology is variable and it depends on the presence and severity of visceral complications.

Late presentation of congenital diaphragmatic hernia

PubMed, 2015

Late presentation of congenital diaphragmatic hernia is 5-30% of all congenital diaphragma hernia cases. It can present as Morgagni, Bochdalek and paraesophageal hernia. Misdiagnosis can result in significant morbiditiy. A 17-month-old girl presented with vomiting and abdominal pain. On physical examination, circulatory disturbance, cyanosis, abdominal distantion were present. Her O2 saturation was 60% and she was tachycardic (180 bpm) and tachypneic (58 bpm) with hypotension (60/35 mmhg). Patient's heart and mediastinum were shifted into the right hemithorax on the chest X-ray. Bowel loops in the left hemithorax with air-fluid levels were seen in her plain X-ray and diaphragmatic hernia was seen in her computed tomography examination. She was referred to our center and operated within an hour. Herniated intestinal loops and stomach were observed from about 2 cm diameter defect of diaphragma were repaired primarily. She was extubated in postoperative 4th day. Late presentation of congenital diaphragmatic hernia may be confused with many situation and is difficult to diagnose without clinical suspicion. Accurate diagnosis and urgent treatment is lifesaving.

[Laparoscopic management of a congenital diaphragmatic hernia]

Gaceta médica de México

Morgagni diaphragmatic hernia is a birth defect whose presentation in adults is rare. Diagnosis is usually made as an incidental finding through image studies; infrequently, patients may present with symptoms such as dyspnea or retrosternal pain. Open surgical repair has been the preferred management method of symptomatic presentation. In this paper we present the case of a 42 year-old-male with symptoms of retrosternal pain and dyspnea. Diaphragmatic hernia diagnosis was made ​​by CT and it was managed by laparoscopic repair of the diaphragmatic hernia.

A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia

The Journal of Medical Sciences, 2016

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.

Diaphragmatic herniation diagnosed at a late stage: an evaluation of eight cases

Turkish Journal of Thoracic and Cardiovascular Surgery, 2012

Bu çalışmada, spesifik klinik özellikleri ve ilginç klinik ve radyolojik tabloları olan ve son evrede tanı konulduktan sonra ameliyat edilen diyafragmatik hernili hastalar analiz edildi. Ça lış mapla nı:Ocak 2006 ve Ağustos 2010 tarihleri arasında son evrede tanı konan ve kliniğimizde ameliyat edilen üçü erişkin ve beşi çocuk toplam sekiz diyafragmatik hernili olgu (4 erkek, 4 bayan; ort. yaş 12.4±24 yaş; dağılım 9 ay-28 yıl) retrospektif olarak değerlendirildi. Tüm hastalarda laparotomi ve torakotomi sonrasında herni redüksiyonu ve primer onarımı yapıldı. Bul gu lar: Çocukların tanısı neonatal dönem sonrasında konuldu. Üç olguya erişkin dönemde tanı kondu. Beş hastada sağ taraflı doğuştan Morgagni hernisi; bir hastada hiatal herni ve iki hastada sol taraflı Bochdalek hernisi mevcuttu. Ameliyattan sonra 5 ila 19. günler arasında tüm hastalar taburcu edildi. Hastanede ortalama kalış süresi 9.8 gündü (dağılım 7-23 gün). Hastalar altı ay ila iki yıl süreyle takip edildi ve anlamlı bir solunum veya gastrointestinal yakınma kaydedilmedi. Morgagni hernisi olan üç olguda da herhangi bir sorun tespit edilmedi. So nuç: Doğuştan olan diyafram hernileri, çoğunlukla neonatal dönemde görülen patolojiler olup, sonrasında bu hernilerin tanısı güçleşebilir. Takip edilen ve deneyimli uzmanlar tarafından klinik olarak tedavi edilen olgularda mortalite ve morbidite oranları düşüktür. Anah tar söz cük ler: Edinilmiş; doğuştan; diyafram; herniasyon. Background: In this study, we aimed to analyze patients with diaphragmatic hernias who had specific clinical features and interesting clinical, radiologic presentations, and had operated following late diagnosis. Methods: A total of eight diaphragmatic hernia cases, of whom three were adults and five were children (4 males, 4 females; mean age 12.4±24 years; range 9 months to 28 years), who were diagnosed in the late period and who were operated on in our clinic between January 2006 and August 2010 were evaluated retrospectively. In all patients, primary repair of the diaphragm was performed following laparotomy and thoracotomy. Results: The children were diagnosed following the neonatal period. Three patients were diagnosed in adulthood. Five patients had right-sided congenital Morgagni hernias, one patient had a hiatal hernia, and two patients had left-sided Bochdalek hernia. All patients were discharged between the 5 th and 19 th postoperative days. The average duration of hospital stay was 9.8 days (range 7 to 23 days). The follow-up time were between six months and two years, and no significant respiratory and gastrointestinal complaints were recorded. No morbidity was detected in three cases with Morgagni hernia. Conclusion: Congenital diaphragmatic hernias are pathologies which are seen in the neonatal period, and the diagnosis of these hernias can be difficult after this period. Mortality and morbidity rates are low in cases who are followed and treated in clinics by dedicated thoracic surgeon.

Congenital Diaphragmatic Hernia - A Late Presentation

Pediatric Oncall, 2021

Congenital diaphragmatic hernia (CDH) occurs due to incomplete muscularization of the diaphragm. While majority of these are diagnosed either antenatally or in the immediate new-born period in view of respiratory distress, a few may remain undiagnosed beyond neonatal period as they are asymptomatic or minimally symptomatic. We report two such cases who presented with respiratory distress and were diagnosed to have late presenting CDH. An eight-year-old male child with weight of 12 kg presented with intermittent fever and cough for one-month, abdominal distension, and occasional bilious vomiting for 15 days and respiratory distress for 2 days. Ultrasonography of the chest revealed herniation of abdominal contents in the left chest cavity and sub-acute intestinal obstruction. He underwent surgery but succumbed to his illness. A 2-year-old female child came to the emergency department with fever, cough for 20 days and respiratory distress for 4 days. X-ray chest showed left large air-fluid filled cavity in the left lung. She underwent emergency laparotomy and a defect in the left hemi-diaphragm with herniation of stomach was noted. The hernia contents were reduced, and diaphragmatic defect closed. Post operatively she recovered well and was discharged after 7 days with full recovery.

Congenital hernias of the diaphragm in children

Journal of Ayub Medical College, Abbottabad : JAMC

Congenital diaphragmatic hernia (CDH) is a major congenital malformation. Different types have been described. Bochdalek hernia (BH) remains most prevalent with high mortality rates. Other variants are less common and carry good prognosis. Although, the diagnosis can be made antenatally, the presentation may be delayed. There is paucity of national literature on CDHs. We present our experience with these challenging paediatric malformations. Medical records of 18 patients (< or =14 years) treated by the group of authors between October 1998 and April 2002 were retrospectively reviewed and demographic data, clinical presentation, morbidity and outcome were studied. There were 13 (72%) children with Bochdalek hernia, 2 (11%) with eventration of the diaphragm, 2 (11%) with hiatus hernia and 1(6%) with a Morgagni hernia. The lesions were more common in girls and all the defects were left sided. The average age at the time of presentation of BH was 23 hours (2 to 72 hours) commonly pr...

Case Reports of Unusual Presentation of Congenital Diaphragmatic Hernia

Proceedings of Shaikh Zayed Medical Complex Lahore, 2019

Introduction: Congenital Diaphragmatic hernia usually presents just after birth with respiratory distress and scaphoid abdomen. The most common type occurs through foramen of Bochdalek. Hiatal hernia in neonates, as well as late presentation of congenital diaphragmatic hernia is very rare. Case Presentation: We report two cases of unusual presentations of diaphragmatic hernias after taking informed consent from the parents. One two-and-a-half-year-old boy presented with repeated chest infection diagnosed as case of Tuberculosis. The second case of neonate with history of reluctance to feed with bulging chest. Conclusion: It is important to identify these presentations, as early correct diagnosis and treatment may be associated with a good outcome, so there is a need for careful clinical examination and proper investigation.

Late-presenting congenital diaphragmatic hernia in childhood

Acta Paediatrica, 2010

To characterize the clinical manifestations of late-presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes. Methods: The records of patients aged 1 month-18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987-June 2008 were reviewed. Results: Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days-9.9 years). Eleven (73%) had left-sided and four (27%) had right-sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%. Conclusion: Late-presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.

Bilateral Morgagni Hernia in Infant, a Rare Type in Congenital Diaphragmatic Hernia: A Case Series

Jurnal Kedokteran Syiah Kuala

Abstrak. Hernia Diafraghma Kongenital (HDK) merupakan kelainan kongenital yang jarang ditemukan pada bayi. Hernia Morgagni bilateral merupakan kasus yang sangat jarang ditemukan. Kami melaporkan kasus ini karena lokasi hernia Morgagni yang bilateral yang sangat jarang dijumpai (kanan dan kiri). Kami laporkan dua kasus dari HDK. Kasus pertama bayi perempuan usia 4 bulan dengan keluhan usus halus dan hati lobus kiri berada di dalam rongga dada yang berhubungan dengan defek anterior dari hernia diafraghma. Kasus kedua neonatus perempuan usia 22 hari datang dengan keluhan distress pernafasan, sesak nafas dan muntah. Pendekatan insisi subcotal dilakukan pada kedua pasien, dan defek dari hernia diafrahgma ditutup dengan menggunakan goretex pacth dengan hasil yang sangat baik. Pasca operasi, kedua pasien dengan kondisi sbaik, dan dipulangkan dari rumah sakit tanpa komplikasi. Berbagai macam teknik tindakan operasi telah dipaparkan, dan pendekatan dengan tindakan laparotomy telah menjadi sa...

Laparoscopic repair of iatrogenic anterior diaphragmatic hernia

Medical Case Studies, 2012

Congenital diaphragmatic hernia is a relatively common condition with an incidence of about 1 in 2000 to 1 in 5000 live births. Most cases occur posterolaterally through the foramen of Bochdalek and usually present immediately after birth with respiratory distress. Congenital anterior diaphragmatic hernia (Morgagni's hernia) is rare, accounting for less than 5% of all types of congenital diaphragmatic hernias. Most of these cases are seen in older children and are usually asymptomatically discovered incidentally or during investigations for some other unrelated condition. Iatrogenic anterior diaphragmatic hernia on the other hand is extremely rare. This report describes an iatrogenic anterior diaphragmatic hernia in a 6-month-old child following cardiac surgery that was repaired laparoscopically. The literature on the subject is also reviewed.

The late presentation of postero-lateral congenital diaphragmatic hernias

Postgraduate Medical Journal, 1992

Four patients presenting after the neonatal period with a combination of respiratory and gastro-intestinal symptoms and signs which point to the diagnosis of congenital postero-lateral diaphragmatic hernias are discussed. Late presentation is more common than previously acknowledged. Early correct diagnosis and treatment are associated with an excellent clinical outcome.

Pediatric Congenital Diaphragmatic Hernia

Journal of Pediatric Care, 2018

Congenital diaphragmatic hernia is a condition characterized by a defect in the diaphragm that leads to the protrusion of the abdominal contents in the thoracic cavity which interferes in the pulmonary development. Diaphragmatic eventration is a very infrequent condition in children, asymptomatic or commonly present with low or gastrointestinal respiratory manifestations and whose diagnosis is based on an incidental finding when requesting images to verify a diagnostic suspicion occurring in most cases of late occurrence. It can be of congenital or acquired cause. The prognosis in general is good, with probable complications being chronic lung infection, diaphragmatic rupture, ulcers and stomach volvulus. Treatment is a topic depend size and location of the defect, size and location of the defect, some pediatric surgeons do not operate if the patient is asymptomatic and only plicate the symptomatic patients. Due to its importance in pediatric population, through this is intended to make a quick review of the updated literature on the subject contributing to have relevant information regarding the issue cooperating with the diagnosis and appropriate treatment in our practice.