Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux

Major thoracic and abdominal trauma damages the diaphragm 5% of the time. These injuries may be recognized when they occur but often are discovered months later during work up for related symptoms. Typically, the injury is to the left posterolateral aspect of the diaphragm. Rarely, rupture through the central diaphragmatic tendon into the pericardial space occurs and this results in different symptoms than the more common injury. We present the case of a patient who presented with chest pain, near syncopal episodes and refractory gastroesophageal reflux years after he was struck by a car and hospitalized. Radiographic imaging included a chest CT that demonstrated herniation of the transverse colon into the mediastinum. During exploration, a defect in the central diaphragm was found with free communication between the peritoneal and pericardial spaces. In this paper, we review our management of this unusual diaphragmatic hernia and the unique symptoms associated with it.     

Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion

Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia (congenital diaphragmatic hernia of Morgagni). We report an early antenatal diagnosis of congenital diaphragmatic hernia of Morgagni with pericardium effussion at 21 weeks' gestation. Two pericardiocentesis were performed at 21 and 22 4/7 weeks' gestation because of recurrence of pericardial effussion. Regular ultrasound assessments showed progressive herniation of the liver to practically fill the right hemithorax. An ex utero intrapartum treatment procedure was performed at 37 weeks' gestation to rescue maximum intrathoracic space for ventilation of the remaining functional lung tissue and to establish an airway for postnatal support. After birth, the patient successfully underwent early correction of the hernia. Postoperative course was uneventful, and the newborn girl was discharged 18 days later without complications and is currently doing well.     

Left-sided diaphragmatic and pericardial ruptures with subluxation of the heart after blunt trauma

We present a rare case of individual but simultaneous rupture of the left pericardium and diaphragm in a patient with multiple blunt trauma. Skeletal trauma was repaired uneventfully with internal plate fixation. Diaphragmatic rupture was suspected and diagnosed 13 days from the initial trauma when the patient exhibited chest pain, dyspnea, and nausea. Intraoperatively, a pericardial rupture was discovered along with subluxation of the heart and repaired with a mesh.     

Combined congenital pericardial and diaphragmatic defects: a case report

This report describes the case of a 62-year-old woman who had a preoperative diagnosis of mitral valve insufficiency. At operation her heart was covered by fat which was identified as omental tissue. The pathogenesis, clinical presentation and management of this disorder are presented.     

Surgical management of left ventricular aneurysms by endoventricular pericardial patch plasty

BACKGROUND: Early and late surgical outcomes of endocardial resection and aneursymectomy repaired with an autologous pericardial patch were studied. METHODS: We studied 125 patients who underwent endoaneurysmorrhaphy with pericardial patch during the period from June 1993 until June 2000. Preoperative, early and late postoperative results, annual postoperative echocardiography of all patients and hemodynamic controls of 35 patients within a mean follow-up of 64+/-8 months were analyzed. RESULTS: Mean NYHA improved to postoperative 2.1+/-0.5 from preoperative 2.8+/-0.4. Mean number of bypass grafts was 2.6+/-1.1. Left ventricular ejection fraction rate improved to 36.2+/-8% in one month, 39.3+/-9% in 6 months, 42.3+/-8% in one year versus preoperative 29.2+/-9% (P< or =0.05).Perioperative mortality was 6.4% (eight patients) and 11 deaths were observed in the late follow-up (9.4%). CONCLUSION: Endoaneurysmorrhaphy with pericardial patch may be an alternative option in the management of left ventricular aneurysms within acceptable surgical results.     

Successful repair of a diaphragmatic hernia through a pericardial window with acellular dermal matrix

A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.     

Balloon plasty for biliary strictures associated with choledochal cysts]

Balloon plasty with a Meditec balloon dilatation catheter was performed in thirteen patients who had choledochal cysts with intrahepatic biliary strictures. The age of the patients ranged from one to 28 years. Eleven were female, and two were male. The site of the biliary stricture was both the right and left hepatic duct in eight patients, the left hepatic duct in four, and the right hepatic duct in one. Balloon plasty was performed postoperatively through the fistula of the percutaneous transhepatic drainage tube in seven patients and during the operation in six. Dilatation was adequate in ten patients but insufficient in three. The preoperative imaging character of the biliary strictures in the successful cases was membranous stenosis of less than 2mm in length. In contrast, the strictures of the patients with insufficient dilatation were long stenoses of more than 5mm in length.     

Congenital diaphragmatic hernias]

Based on their personal experience the authors affirm that if treated early congenital diaphragmatic hernia may be resolved provided no congenital anomalies are present. Pulmonary hypoplasia is secondary to the presence of viscera in the thorax, but excellent results can be obtained if early surgery is performed and provided negative-pressure thoracic drainage and correct anesthesia are ensured. Mortality is due to associated visceral malformations.     

A case of intrapericardial diaphragmatic hernia with a massive pericardial effusion: fetal diagnosis and therapy

Intrapericardial diaphragmatic hernia is a very rare phenotype of neonatal diaphragmatic hernia which is thought to be caused by the developmental failure of the septum transversum. There have been only 10 cases reported since 1980, and among them, only 2 cases were diagnosed in fetal life. We herein report a new case that was diagnosed in fetal life, and pericardiocentesis was performed at 27 weeks of gestation. This is the first case to undergo a fetal interventional therapy. After birth, the patient successfully underwent closure of the hernia, despite severe pulmonary hypoplasia.     

Triple diaphragmatic rupture with disruption of the pericardium: pericardial reconstruction by lyophilized dura allograft

A patient is described with the unusual findings of intrapericardial diaphragmatic rupture combined with total disruption of the pericardium and partial abruption of the diaphragm from its costal origin. Through a third traumatic diaphragmal leak, the small intestine had prolapsed intercostally without contact to the pleural space. Surgical repair was done by direct diaphragmatic suturing and lyophilized dura allograft reconstruction of the left pericardial circumference. Postoperatively, atrioventricular block secondary to myocardial contusion necessitated pacemaker implantation. The patient left the hospital five weeks after the injury.     

口内进路高颧骨整形术

高颧骨整形术中为达到理想的美容效果，必须将颧部整形与面部其他器官的美容作一个整体来考虑，文中介绍了矫正高颧骨畸形的一种新的手术方法，手术进路有两种，一种是口内，另一种是冠状切口，自１９９４上１２月至１９９６年２月，通过口内进路设计一种Ｖ形切口，用骨切削技术矫正高颧骨畸形，共施术于２５例病人，手术简单，安全，可对门诊病例采用局部麻醉施行手术，本组病人大多数经６月至１年以上随方，术后显示疗效满意，暂时