Vólvulo gástrico por hernia diafragmática crónica / Gastric volvulus due to chronic diaphragmatic hernia

Objetivo: Presentar un caso de vólvulo gástrico obstructivo. Caso clínico: Presentamos el caso de una paciente que inició con un episodio de obstrucción intestinal por una volvulación gástrica. El antecedente de otro episodio antiguo y la radiología de tórax alertaron de una posible hernia diafragmática crónica. La buena respuesta al tratamiento médico inicial permitió un estudio completo y una cirugía programada mediante abordaje laparoscópico.

Aim: To present a patient with gastric volvulus. Case report: A case of a female patient who started with an episode of intestinal obstruction due to gastric volvulus. The history of a former episode and chest radiology alerted us to a possible chronic diaphragmatic hernia. The patient's good response to initial medical treatment allowed a complete study and laparoscopic intervention.

Anaesthesia for infant with Jarcho Levin syndrome: case report / Anestesia em criança com síndrome de Jarcho-Levin: relato de caso

ABSTRACTJarcho Levin syndrome is a rare disorder. There are various vertebral and costal anomalies. Severe deformities and abnormal fusion of ribs and vertebrae cause respiratory insufficiency and pneumonia. We present anaesthesia in a patient with Jarcho Levin syndrome for vesicoureteral reflux.

RESUMOA síndrome de Jarcho-Levin é um distúrbio raro que apresenta várias anomalias vertebrais e costais. Deformidades graves e fusões anormais das costelas e vértebras causam insuficiência respiratória e pneumonia. Apresentamos um caso de anestesia em paciente com síndrome de Jarcho-Levin para refluxo vesicuretral.

Oclusión intestinal por hernia de Bochdalek / Intestinal occlusion caused by Bochdalek hernia

La hernia de Bochdalek es un defecto congénito de la región posterolateral del diafragma, usualmente del lado izquierdo, se presenta en 1 de cada 2 000-5 000 nacidos vivos, su diagnóstico en el momento del nacimiento es relativamente fácil, no así cuando este debe realizarse después del período neonatal, pues puede conllevar a evaluaciones erróneas desde el punto de vista clínico y radiológico. La presentación tardía de esta entidad no es frecuente, por lo que nos proponemos dar a conocer un caso de oclusión intestinal por hernia diafragmática de presentación tardía y revisar la literatura al respecto. Se presenta un lactante de 5 meses producto de un tercer embarazo, parto distócico por presentación pelviana, oligoamnios, Apgar 9-9, antecedentes de salud hasta el cuarto mes en que se le introduce leche de chiva y comienza con regurgitaciones bastante frecuentes. Se le realiza diagnóstico a los 5 meses de oclusión intestinal por hernia diafragmática congénita. Se interviene quirúrgicamente sin complicaciones posoperatorias, es dado de alta a los 7 días, y seguido por consulta externa, con evolución satisfactoria. La hernia diafragmática congénita, cuando se presenta después del periodo neonatal, puede diagnosticarse incidentalmente en un estudio radiológico, o por complicaciones secundarias al paso de las vísceras abdominales al tórax

Bochdalek hernia is a congenital defect of the posterolateral region of the diaphragm, usually located on the left side. It appears in one per 2000 to 5000 live births; the diagnosis at birth is relatively easy but after the neonatal period, it can lead to erroneous assessments from the clinical and radiological viewpoints. The late-presenting hernia is not frequent, so we intended to present a case of intestinal occlusion caused by late-presenting diaphragmatic hernia and to make a literature review on this topic. Here is the case of a 5 months-old infant born from a third pregnancy, which was dystotic as a result of pelvic presentation and with oligohydramnios. He had an Apgar score of 9.9 and a history of health problems until his fourth month of life when he began to be fed with goat's milk and it appeared pretty frequent regurgitation. He was diagnosed at 5 months of life with intestinal occlusion due to congenital diaphragmatic hernia. He was operated on, no complications were observed and then he was discharged from the hospital after 7 days and followed-up at outpatient service, with satisfactory recovery. The congenital diaphragmatic hernia that occurs after the neonatal period can be incidentally diagnosed in a radiological study or because of secondary complications when abdominal viscerae passed into the thorax

Hernia diafragmática congénita atascada / Stuck congenital diaphragmatic hernia

La hernia diafragmática congénita constituye uno de los retos pendientes dentro de las enfermedades quirúrgicas del recién nacido. Se presenta un caso muy inusual, en el cual se diagnosticó una hernia diafragmática derecha atascada, con compromiso de gran parte del intestino. Se describen los medios diagnósticos utilizados, el procedimiento quirúrgico realizado y las complicaciones presentadas. La hernia diafragmática congénita atascada es una complicación potencialmente letal, por el amplio compromiso vascular que produce en los órganos abdominales y que conlleva a la necrosis de estos si no se diagnostica precozmente. Por ello, debe ser considerada en el diagnóstico diferencial de la insuficiencia respiratoria en los recién nacidos y lactantes pequeños

Congenital diaphragmatic hernia is one of the pending challenges in dealing with the surgical diseases of the newborn. This was a very unusual case of a right stuck diaphragmatic hernia that affected a large part of the intestine. The used diagnostic means, the surgical procedure and the observed complications were described. Stuck congenital diaphragmatic hernia is a potentially lethal complication because of the wide vascular effect on the abdominal organs, leading to their necrosis if this problem is not early diagnosed. Therefore, it must be taken into account in the differential diagnosis of the respiratory failure in newborns and small infants

Hernia diafragmática complicada con rotura de víscera hueca dentro de la cavidad torácica / Complicated diaphragmatic hernia with hollow viscus rupture in thoracic cavity

Introduction: diaphragmatic hernias (DH) are a rare condition in adult patients. Most of the cases are asymptomatic findings in imaging studies. Rarely do they present as complicated cases. Clinical cases: we report two clinical cases of complicated DH, one of Bochdalek and another with history of a penetrating thoracic trauma two years before, both with hollow viscus rupture in the thoracic cavity.

Introducción: las hernias diafragmáticas (HD) son una patología relativamente poco frecuente en adultos. La gran mayoría son hallazgos asintomáticos en exámenes de imágenes, y en ocasiones debutan con complicaciones de éstas. Casos clínicos: se presentan dos casos clínicos de HD, una de Bochdalek y otra con antecedente de trauma penetrante torácico hace 2 años, ambas complicadas con rotura de víscera hueca en la cavidad torácica.

Oclusión intestinal por hernia diafragmática derecha encarcelada / Intestinal occlusion for incarcerate left diaphragmatic hernia

La hernia de Morgagni es un defecto congénito de la cara anteromedial del diafragma, que se presenta de forma infrecuente en el adulto. En la mayor parte de los casos su diagnóstico es un hallazgo incidental, y por lo general, los pacientes se encuentran asintomáticos. Se diagnostican radiológicamente y posteriormente se indica la cirugía por el riesgo de estrangulación. Se presentó un caso clínico de una paciente de 78 años, con previo diagnóstico de hernia diafragmática derecha mediante técnicas imagenológicas, que comenzó con manifestaciones de cuadro oclusivo. Fue operada de urgencia por vía transabdominal, se hizo la reducción del saco herniario donde se encontraba epiplón, colon transverso y parte del estómago, y se reparó el defecto diafragmático. El propósito de este trabajo fue reportar un caso reciente de oclusión intestinal causada por hernia de Morgagni encarcelada, su diagnóstico y abordaje quirúrgico.

The Morgagni hernia is a congenital defect of the diaphragm anteromedial side, infrequently present in adults. In most of the cases its diagnosis is an incidental finding, and in general the patients are asymptomatic. They are diagnosed radiologically, and once diagnosed the surgery is indicated to avoid the risk of strangulation. We presented the clinical case of a 78-years-old female patient with a previous diagnosis of left diaphragmatic hernia obtained using imaging techniques, who began with manifestations of an occlusive picture. She was immediately operated by transabdominal way, reducing the hernia sac containing mesentery, transversal colon and part of the stomach, and the diaphragmatic defect was repaired. The purpose of this work was reporting a recent case of intestinal occlusion caused by incarcerated Morgagni hernia, its diagnosis and surgical management.

Chronic Gastric Volvulus by Diaphragmatic Hernia and Gastroparesis / 대한소화기학회지

No abstract available.

Neonatal gastric volvulus: another cause of “Mucousy Baby” with gasless abdomen.

Neonatal acute gastric volvulus is rare and often associated with diaphragmatic anomalies. Patients usually present with vomiting and respiratory distress, but excessive salivation, failure to pass a nasogastric tube beyond 20 cms and the presence of a space occupying thoracic lesion should also prompt a search for the entity. The authors describe a case presenting with these atypical findings and stress the importance of the plain radiograph chest to make a diagnosis.

Morgagni hernia with down syndrome: A rare association.

We report a case of a 22-year-old male with Down syndrome and Morgagni hernia, who presented to us with complaints of cough, regurgitation and vomiting. He was successfully treated surgically and the defect was repaired with prolene mesh.

Obstructed Bochdaleck diaphragmatic hernia in a child girl

A five-year-old female child presented with intestinal obstruction. X-ray abdomen and chest showed multiple air-fluid levels in abdomen and a single gas shadow with air-fluid level in left hemithorax. Ultrasound confirmed the presence of gut loop in left side of chest. Laparotomy was carried out with repositioning of intestinal loops in abdominal cavity and closure of posterolateral diaphragmatic defect with non-absorbable suture. Patient recovery was uneventful. As soon as diagnosis of diaphragmatic hernia is made, surgical intervention should be made to prevent fatal complications

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.

O valor da ultra-sonografia e da ressonância magnética fetal na avaliação das hérnias diafragmáticas / The value of fetal ultrasonography and magnetic resonance imaging in the assessment of diaphragmatic hernias

OBJETIVO: Demonstrar a significância dos achados da ressonância magnética e da ultra-sonografia na caracterização pré-natal e avaliação do prognóstico de pacientes com hérnia diafragmática congênita. MATERIAIS E MÉTODOS: Catorze gestantes (idade gestacional média de 28,7 semanas) examinadas com ultra-sonografia e apresentando fetos com suspeita de hérnia diafragmática congênita foram avaliadas por meio da ressonância magnética. Os exames foram realizados em aparelho de 1,5 tesla usando seqüências-padrão. Dois radiologistas avaliaram as imagens e estabeleceram os achados por consenso. RESULTADOS: Doze fetos tinham hérnia diafragmática à esquerda e dois, à direita. O fígado fetal foi localizado no interior do tórax de cinco fetos pela ultra-sonografia (três com hérnia diafragmática esquerda e dois com hérnia diafragmática direita) e de oito pela ressonância magnética (seis com hérnia diafragmática esquerda e dois com hérnia diafragmática direita). Herniação do estômago e alças de intestino delgado foi observada em todos os fetos com hérnia diafragmática esquerda (n = 12), tanto pela ultra-sonografia quanto pela ressonância magnética. Oito fetos sobreviveram após cirurgia (sete com hérnia diafragmática esquerda e um com hérnia diafragmática direita). CONCLUSÃO: A ultra-sonografia e a ressonância magnética são métodos de imagens complementares na avaliação das hérnias diafragmáticas congênitas. A ressonância magnética pode auxiliar a ultra-sonografia na avaliação da posição do fígado, o qual representa importante fator prognóstico.

OBJECTIVE: To demonstrate the relevance of ultrasonography and magnetic resonance imaging findings in the prenatal characterization and prognostic evaluation in cases of congenital diaphragmatic hernia. MATERIALS AND METHODS: Fourteen pregnant women (mean gestational age = 28.7 weeks) who had undergone ultrasonography for suspicion of fetuses with congenital diaphragmatic hernia were assessed by means of magnetic resonance imaging on a 1.5 tesla equipment, following the standard protocol. Two radiologists evaluated the images and the findings were defined by consensus. RESULTS: Twelve fetuses had left diaphragmatic hernia and two, right diaphragmatic hernia. Ultrasonography showed the fetal liver inside the thorax of five fetuses (three with left diaphragmatic hernia, and two with right diaphragmatic hernia) and magnetic resonance imaging in eight fetuses (six with left diaphragmatic hernia, and two with right diaphragmatic hernia). Stomach and small bowel loop herniation was observed in all of the fetuses with left diaphragmatic hernia (n = 12) at both magnetic resonance imaging and ultrasonography. Eight fetuses (seven with left diaphragmatic hernia and one with right diaphragmatic hernia) survived after surgical treatment. CONCLUSION: Ultrasonography and magnetic resonance imaging are complementary imaging methods in the evaluation of congenital diaphragmatic hernia. Magnetic resonance imaging is a helpful diagnostic method complementary to ultrasonography for evaluation of the fetal liver positioning, considering its relevance as a prognostic factor in cases of congenital diaphragmatic hernia.

Obstructed Morgagni's hernia.

Morgagni's Hernia is the direct herniation of the intra-abdominal organs through the anterior retrocostoxiphoid diaphragmatic defect. We are presenting a case of obstructed Morgagni's hernia in a five-year-old child. Who presented with colicky abdominal pain, distention of upper abdomen, vomiting with constipation of three days duration.. Morgagni hernia is a rare disease even rarer in pediatric age group, and is usually diagnosed incidentally; presentation of this disease with obstruction had been reported in adult but not in children.

Traque-oclusão intra-útero: técnica cirúrgica assistida à corticoterapia promove aumento nos receptores de VEGF (Vascular Endothelial Growth Factor) em pulmões de fetos de ratas / In utero tracheal occlusion: surgical approach associated to steroid treatment increase VEGF (Vascular Endothelial Growth Factor) receptors in lungs of fetal rats

A hérnia diafragmática congênita (HDC) causa hipoplasia e hipertensãopulmonar e em geral leva a alta morbidade e mortalidade neonatal. Traqueo-oclusão fetal (TO) e corticoterapia pré-natal são alternativas para acelerar o crescimento pulmonar fetal e diminuir a hipoplasia na HDC. A produção de VEGF (Vascular Endothelial Growth Factor) está relacionada com a maturidade pulmonar e sofre alterações na HDC ainda não elucidadas.Materiais e métodos: Seis grupos de 12 fetos de ratos Spreague-Dawley foram comparados: TO, Sham, Controle, TO+Dex, Sham+Dex e Controle+Dex. No dia 18,5º foi realizada TO come sem corticoterapia utilizando dexametasona. No 21,5º dia gestacional os pesos corporal e...

Congenital diaphragmatic hernia (CDH) presents with hypoplastic lungs and usually leads to pulmonary hypertension and high neonatal mortality. Fetal tracheal occlusion (TO) and prenatal corticotherapy are alternatives to accelerate fetal pulmonary growth and decrease hypoplasia in CDH. VEGF (Vascular Endothelial Growth Factor)production and surfactant production by type II pneumocytes are related with pulmonary maturity and are altered in CDH, but little has been described about VEGF receptors. Our objective wasto quantify the receptors of VEGF (VEGFR) and type II pneumocytes, verifying the effects of TO and corticotherapy on normal lungs of fetal rats...

Hernia diafragmática, diagnóstico prenatal y seguimiento / Diaphragmatic hernia, prenatal diagnosis and follow up

La hernia diafragmática congénita es un defecto del diafragma que permite el desplazamiento de los órganos abdominales hacia la cavidad torácica. A pesar de los avances en el manejo prenatal y postnatal, esta malformación se asocia a una elevada mortalidad. Se presenta una revisión de los casos clínicos con diagnóstico prenatal de hernia diafragmática ingresados al CERPO durante el período 2003-2005. Se analiza en cada caso la edad gestacional al diagnóstico, lado afectado, compromiso hepático, asociación con otras malformaciones y cromosomopatías, resultado perinatal, cirugía y evolución.

Respiratory distress in neonates.

Respiratory distress due to either medical or surgical causes occurs commonly in neonates. It is the most common cause of admission to a neonatal surgical intensive care facility in a tertiary care hospital. The distress can be caused by a variety of clinical conditions; common conditions treated in medical intensive care units are transient tachypnea of the new born, respiratory distress syndrome, pulmonary air leak and pneumothorax. In surgical causes of respiratory distress in neonates the underlying mechanisms include airway obstruction, pulmonary collapse or displacement and parenchymal disease or insufficiency; the common causes are congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, congenital lobar emphysema and esophageal atresia with or without tracheo-esophageal fistula. Obstructive lesions of the new born airway include choanal atresia, macroglossis, Pierre-Robin syndrome, lymphangioma, teratoma or other mediastinal masses, cysts, subglottic stenosis and laryngo tracheomalacia. Imaging plays a very major role in the pre-operative diagnosis of these conditions and proper pre-operative resuscitation helps in improving the results of surgery dramatically.

Bifid liver in a patient with diaphragmatic hernia.

Liver malformations including lobe and segmental abnormalities are rare. We report a 65-year-old lady with complaints of breathlessness and fullness after meals for two months. Investigations revealed a diaphragmatic hernia on the right side with a bifid liver; the right lobe of the liver was among the hernia contents. The lady is asymptomatic after surgical repair.