Congenital cystic adenomatoid malformation associated with ipsilateral eventration of the diaphragm

A two-month-old girl was operated for a left-sided eventration of the diaphragm. At surgery, a mass representing an extralobar pulmonary sequenstration (EPS) was found inferior to the left lobe of the lung and was excised. Histopathological examination of the resected specimen showed presence of a type II congenital cystic adenomatoid malformation (CCAM) within it. A review of the relevant literature is presented.     

Neonatal arrhythmia with diaphragmatic eventration

Supraventricular tachycardia is the most common symptomatic arrhythmia in young patients, frequently associated with Wolff-Parkinson-White (WPW) syndrome. We report a case of supraventricular tachycardia with Wolff-Parkinson-White (WPW) syndrome associated with partial eventration of a diaphragm in a neonate.     

经胸腔镜手术治疗13例新生儿及小婴儿膈膨升

目的 介绍胸腔镜下手术矫治新生儿及小婴儿膈膨升的治疗经验.方法 回顾性分析我院2011年4月至2013年7月经胸腔镜手术治疗的13例新生儿及小婴儿膈膨升临床资料.13例中,右侧11例,左侧2例;男性10例,女性3例;年龄8～177 d,平均96 d;体重2.5～6.9 kg,平均4.8 kg;均采取三孔法,在胸腔镜下行膈肌折叠术.结果 12例顺利经胸腔镜完成手术,1例因合并胎粪性腹膜炎而中转开腹手术.术后用氧时间36～ 150 h,平均66 h;住院时间6～14d,平均9d,术后胸片膈面位置均基本正常,随访3个月至2年,所有患儿生长发育正常,无一例复发.结论 经胸腔镜手术治疗新生儿、小婴儿膈膨升安全有效,能达到微创效果,但术者需具备熟练的微创手术技术及掌握适当的手术技巧.     

Congenital eventration of the diaphragm

Ultrasound was utilized in 3 infants to diagnose preoperatively eventration of the diaphragm. In all children the organ simulating a chest mass was the liver.     

Incarcerated diaphragmatic hernia with gangrene and intestinal obstruction

A case of diaphragmatic hernia complicated by incarceration, gangrene, and intestinal obstruction in a 10-year-old boy is reported. Separate abdominal and thoracic incisions were required to reduce the hernia and a major bowel resection was necessary.     

儿童先天性心脏病术后行膈肌折叠手术的临床观察研究

目的:分析儿童先天性心脏病(CHD)术后行膈肌折叠术(DPL)的危险因素、时机和临床疗效。方法:回顾性分析2017年1月至2019年12月在上海儿童医学中心行CHD手术患儿的临床资料,根据CHD术后是否行DPL分为DPL组和未行膈肌折叠术组(NDPL组),比较两组患儿年龄、CHD术式、术次、体外循环(CPB)时间等临床...     

Successful management of bilateral congenital eventration of the diaphragm

A case of bilateral congenital eventration of the diaphragm is reported. Antenatal ultrasonography indicated the presence of a left diaphragmatic hernia; severe respiratory distress was present immediately following birth, and with the patient at the age of 7 h plication of the membranous left hemidiaphragm was performed. Postoperatively, respiratory distress persisted; X-ray films revealed an elevated right hemidiaphragm, which was plicated on the 11th day of life.     

Congenital eventration of the diaphragm — 45 years' perspective

Fifty-five children with congenital eventration of the diaphragm were operated upon in a single tertiary-care children's hospital during the 45-year period from 1948 to 1992. The study was divided into three periods: 1948–1962, 1963–1977, 1978–1992. There were 14 patients in the first group, 26 in the second, and 15 in the third. Children later in the series presented earlier and with more acute symptoms. Mortality was related to severe pulmonary hypoplasia and associated anomalies, especially chromosomal defects: 14% during the first period, 27% during the second, and 7% during the third.     

胸腔镜下膈肌折叠术治疗婴幼儿右侧膈膨升

目的总结胸腔镜下膈肌折叠术治疗婴幼儿膈膨升的临床经验及疗效。方法自2009年2月至2011年12月作者收治儿童膈膨升15例。其中男12例,女3例,年龄3个月至3岁（平均年龄9个月）,回顾性分析手术方法、手术时间、住院时间、患儿康复及随访情况。结果15例均为右侧膈膨升,均在胸腔镜下顺利完成膈肌折叠术。手术时间1-3．5h（平均约2．5h）。术中出血少,无一例并发症,无中转开胸病例。患儿于术后3～7d出院,平均术后住院时间5．2d,2例术后出现肺部感染。术后随访2个月至2年,疗效满意,胸部正位片显示患儿膈肌分别较术前降低1～3个肋间隙,胸壁创伤小,外观满意。结论胸腔镜下膈肌折叠术适合于婴幼儿膈膨升,具有创伤小,恢复快,胸廓外观影响小的优势。     

Congenital diaphragmatic eventration detected by antenatal ultrasound: Rationale for early operation

A rare prenatal case of congenital diaphragmatic eventration is reported. Fixed elevation of the right hemidiaphragm since the early fetal period suggests irreversibility of the eventration. A rationale for early surgical plication in symptomatic congenital eventration is proposed.     

腹腔镜下膈肌折叠术治疗小儿先天性右侧膈膨升的疗效分析

目的探讨腹腔镜下膈肌折叠术治疗小儿先天性右侧膈膨升的可行性。方法选取2002年1月至2013年12月于本院诊断为右侧膈膨升,并行膈肌折叠术的患儿17例,其中7例采取开放性手术(均经腹完成手术),为开放手术组;10例采取腔镜手术,为腹腔镜手术组。结果17例手术均获成功,术后胸片(DR)复查膈肌反常运动消失,Kienbock征均为阴性。治愈16例中,经开放手术治愈6例,腹腔镜手术治愈10例。开放手术组平均手术时间145 min,术后住院时间(11.19±2.29)d,术后1例并发切口感染,经换药至切口愈合出院;腹腔镜手术组平均手术时间130 min,术后住院时间(8.86±2.31)d,无一例发生并发症。随访半年至2年,无一例复发。结论腹腔镜治疗膈膨升相对安全,创口小,恢复快,效果满意,且可实现对腹腔其他脏器的探查,是值得推广的微创手术方式。     

Diagnosis of delayed onset right-sided congenital diaphragmatic hernia using ultrasonic and radionuclide imaging

A right-sided Bochdalek diaphragmatic hernia is often a difficult diagnosis to establish because the onset of clinical symptoms may be delayed or preceded by Group B streptococcal pneumonia, or may produce confusing findings on chest radiographs. In two cases, real time ultrasonography and radionuclide liver scans readily diagnosed diaphragmatic interruption and intrathoracic herniation of the liver. Offprint requests to: A. R. Nussbaum     

A case of neonatal bilateral diaphragmatic paralysis requiring surgery

Abstract Diaphragmatic paralysis may cause life threatening respiratory distress especially in infancy. A case is reported of a 32 week gestation infant with bilateral phrenic nerve palsies and associated brachial plexus injury who remained severely compromised despite spontaneous recovery of the right hemidiaphragm after 13 weeks. Operative plication of the left hemidiaphragm produced a marked improvement. Surgery should be considered after an adequate trial of expectant management in symptomatic patients.     

Accessory diaphragm associated with respiratory distress in a neonate

Supernumerary diaphragm is a rare congenital abnormality. This paper describes a neonate with respiratory distress caused by an overdistended left upper lobe and atelectasis of the left lower lobe entrapped below the accessory hemidiaphragm. Excision of the membrane dividing the hemithorax led to an uneventful recovery. Offprint requests to: I. Milovic     

Hemothorax- A rare presentation of congenital strangulated diaphragmatic hernia

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed.     

“Acquired” congenital diaphragmatic hernia

A case of late presentation of left congenital diaphragmatic hernia (CDH) in a boy of 9 months is reported. A chest X-ray taken after (premature) birth gave normal results; hence this type of CDH is called acquired. Not being associated with pulmonary hypoplasia, this condition is difficult to diagnose. The patient presented as an emergency and the initial diagnosis was tension pneumothorax. This resulted in the insertion of a chest tube, fortunately without damage to the herniated stomach and spleen. Doubling upward of the tip of the nasogastric tube led to the correct diagnosis. After successful repair of the diaphragm the child made a full recovery.Abbreviations CDH congenital diaphragmatic hernia - CPAP continuous positive airway pressure     

Left diaphragmatic hernia associated with lower esophageal atresia

A case of combined left diaphragmatic hernia and lower esophageal atresia, which is an unusual occurrence, is described. The preoperative diagnosis was difficult because of the presence of an abnormal air bubble, thought to be the stomach, in the chest. The surgical management is discussed. Correspondence to: N. Komi     

Congenital diaphragmatic hernia: experience without extracoporeal membrane oxygenation

While extracorporeal membrane oxygenation (ECMO) is used in the management of congenital diaphragmatic hernia (CDH), its value is questioned. The charts of all newborn infants who presented in respiratory distress due to CDH over the past 27 years were reviewed. Inborn versus outborn, year of repair, use of ultrasound (US), and the predictive value of various parameters was evaluated. Fisher's exact test and logistic regression tests were used to analyze data. There were 81 patients, 43 males and 38 females. Repair occurred after stabilization without ECMO; 65 patients survived (80%). Apgar scores at 1 min (P=0.03) and 5 min (P=0.005), best postductal PaO₂ (BPDPaO₂) (P=0.02), and type of repair (P=0.01) were predictive of outcome. There was no difference in survival between inborn and outborn patients or over the years of review (P=0.29). Forty-six patients had documented prenatal US scans, with no obvious impact on outcome. Thus, survival of CDH patients without ECMO is comparable to the best results reported with ECMO, suggesting that the costs and associated morbidity of ECMO may not justify its use for such patients. Apgar scores, BPDPaO₂, and type of repair are good predictors of outcome. Accepted: 9 March 2001     

The cardiopulmonary consequences of high-risk congenital diaphragmatic hernia

The cardiopulmonary effects of high-risk congenital diaphragmatic hernia have been studied in 50 neonates at The Children's Hospital Boston, from October 1982 through February 1987. Extracorporeal membrane oxygenation (ECMO) was added in February 1984 as therapy for infants who failed to respond to conventional therapy and had 100% predicted mortality. Twenty-three patients received ECMO support; 19 underwent cardiac catheterization immediately after surgery and had hemodynamic parameters measured and pulmonary angiograms performed. The infants fell into two physiologic groups based on their ability to achieve a postductal P O₂ 100: responders and nonresponders to conventional therapy. Responders most often began with left-to-right shunting, and therefore had a pulmonary vascular bed large enough to accept a full cardiac output, even though it was hypoplastic. Their episodes of right-to-left shunting were mostly caused by severe pulmonary aterial vasospasm, which could be reversed in many instances. Nonresponders never showed an ability to accept a cardiac output, and therefore had severe hypoplasia as a limiting condition. Survival was 68% in the responders and 8% in the nonresponders. Overall survival was 49%. Of the patients placed on ECMO, 82.6% were weaned successfully but 65.2% died eventually, most often due to complications of chronic ventilator support. Preliminary analysis of the lungs demonstrated significant iatrogenic damage, but showed some evidence of pulmonary growth. These data suggest that if support can be provided with less iatrogenic injury after ECMO, pulmonary vascular remodeling and growth may be sufficient for improved survival. Offprint requests to: J. P. Vacanti at the Children's Hospital