Preliminary study on the value of fetal MRI lung volume and mediastinal shift angle for predicting prognosis of left congenital diaphragmatic hernia / 中华放射学杂志

Objective:To explore the value of fetal lung volume and mediastinal shift angle (MSA) based on fetal MRI in predicting the prognosis of congenital diaphragmatic hernia (CDH).Methods:Fetuses with left CDH that did fetal MRI in Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine from September 2016 to January 2022 were retrospectively collected. There were 65 patients, and their gestational age was 29 (26, 35) weeks when they were diagnosed with left CDH by MRI. Observed fetal lung volume and MSA were measured based on fetal MRI, and observed/expected lung volume (o/eFLV) based on gestational age was calculated. The clinical data were collected from birth to discharge, and patients were divided into survival group and death group in case of prognosis at discharge, with 54 cases in the survival group and 11 cases in the death group. The student′s t test was used to compare the difference of o/eFLV and MSA between the survival group and the death group, and the receiver operating characteristic (ROC) curve was used to evaluate the value of o/eFLV and MSA in predicting the prognosis of left CDH. Results:The o/eFLV of the survival group was 51.5%±18.3%, higher than that of the death group (27.8%±4.4%), and the difference was significant ( t=8.29, P<0.001). The MSA of the survival group was 33.1°±1.2°, lower than that of the death group (41.8°±2.7°), and the difference was significant ( t=-11.15, P<0.001). The area under the ROC curve (AUC) of o/eFLV to predict the fetal survival or death was 0.939 (95%CI 0.851-0.983), the cutoff value was 33.8%, the sensitivity was 100%, the specificity was 88.9%. The AUC of MSA was 0.998 (95%CI 0.941-1.000), the cutoff value was 37.2°, the sensitivity was 100%, the specificity was 98.2%. Conclusions:The o/eFLV and MSA that were measured based on fetal MRI can effectively predict the fetus′s prognosis with left CDH.

Hernia diafragmática derecha postraumática de presentación tardía. Un caso infrecuente / Post-traumatic right diaphragmatic hernia of late presentation. A rare case

RESUMEN La hernia diafragmática traumática se define como el paso del contenido abdominal a la cavidad torácica a través de un defecto en el diafragma producido por un trauma. Su diagnóstico es difícil, a menudo puede pasar inadvertido, debido a la gravedad de las lesiones que le acompañan. Las claves para el diagnóstico son un alto grado de sospecha y el conocimiento de los distintos signos en la tomografía computarizada. Una vez diagnosticada la ruptura diafragmática, se repara quirúrgicamente para evitar complicaciones. Se presenta el caso de un paciente masculino, de 88 años de edad con antecedentes de haber sufrido trauma toracoabdominal cerrado hacía 35 años, que acudió con un cuadro clínico de oclusión intestinal. Se publica este caso porque, además de ser una entidad poco frecuente, resulta importante el conocimiento de esta enfermedad, para valorarla dentro de las posibilidades diagnósticas en aquellos pacientes que aquejen síntomas relacionados con sus complicaciones.

ABSTRACT Traumatic diaphragmatic hernia is defined as the passage of abdominal contents into the thoracic cavity through a defect in the diaphragm caused by trauma. The diagnosis of traumatic diaphragmatic hernia is difficult, it can often go unnoticed, due to the seriousness of the accompanying injuries. The keys to diagnosis are a high degree of suspicion and knowledge of the various signs on computed tomography. Once the diaphragmatic rupture is diagnosed, it is surgically repaired in order to avoid complications. The case of an 88-year-old male patient with a history of having suffered closed thoracoabdominal trauma 35 years earlier, who presented with a clinical picture of intestinal obstruction is presented. This case is published because, in addition to being a rare entity, knowledge of this disease is important, in order to assess it within the diagnostic possibilities, in those patients who suffer from symptoms related to its complications

Diaphragmatic perforation after transcatheter arterial chemoembolization of hepatocellular carcinoma via inferior phrenic artery: a case report.

BACKGROUND: Transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery has been recognized to have its own therapeutic role without causing serious procedural complications. We report a case of diaphragmatic perforation after repeated TACE sessions conducted via the right inferior phrenic artery. CASE PRESENTATION: A 43-year-old man diagnosed with hepatocellular carcinoma was admitted to the hospital with a chief complaint of cough. The patient underwent TACE via the right inferior phrenic artery 3 months prior and was discharged without specific complications. Physical examination revealed decreased breathing sounds in the right lower lung zone. Chest radiograph demonstrated a small right pleural effusion. Chest CT scan revealed a small diaphragmatic perforation. The patient was unable to undergo surgical exploration, and a follow-up CT scan after 2 months revealed progression of the right diaphragmatic perforation with massive herniation of omental fat into the thoracic cavity. CONCLUSIONS: Although TACE via the inferior phrenic artery is a relatively safe procedure, it can be associated with rare but serious complications after repeated procedures. This is a rare case report of diaphragmatic perforation after TACE via the right inferior phrenic artery. Early recognition and prompt surgical management are essential to prevent catastrophic outcomes.

Value of MRI findings for the evaluation of a hernia sac in fetuses with congenital diaphragmatic hernia / 中华放射学杂志

Objective:To explore the value of MRI signs in assessing the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia.Methods:MRI images of 57 patients with congenital diaphragm hernia confirmed by postpartum surgery were analyzed from November 2016 to December 2020 in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, with a gestational age of 20－40 (28±5) weeks. In postpartum surgery, 18 cases were found with hernia sacs (hernia sac group) and 39 cases without hernia sacs (hernia-free group). Seven MRI signs were analyzed, including hernia peripheral enveloping sensation, smooth lung-hernia interface, crescent-shaped lung compression, residual lung tissue on the affected side, heart displacement, effusion above the lung-hernia interface and effusion below the lung-hernia interface. The differences in MRI signs between the hernia sac and hernia-free groups were compared using the χ 2 test or Fisher′s exact probability method. The diagnostic efficacy of each sign was calculated. The MRI signs with statistical differences between the two groups were included in the predictive integration model, and 1 point was scored for each sign, the imaging score of each fetus was calculated, and the efficacy of imaging points in diagnosing the presence or absence of hernia sacs was assessed by the subject manipulation receiver operating characteristics (ROC) curve. Results:There were statistically significant differences in 5 MRI signs between the hernia sac and the hernia-free groups, namely hernia peripheral enveloping sensation (χ2=25.74, P<0.001), smooth lung-hernia interface (χ2=48.20, P<0.001), crescent-shaped lung compression (χ2=57.00, P<0.001), residual lung tissue on the affected side (χ2=12.14, P<0.001) and effusion above the lung-hernia interface (χ2=4.31, P=0.022). Among them, the sign of crescent-shaped lung compression had the highest diagnostic efficacy, and the sensitivity, specificity and accuracy all were 100%. Five statistically significant MRI signs were included in the predictive integration model, and the area under the ROC curve was 0.999, the sensitivity was 100%, the specificity was 94.9%, and the optimal threshold was 2 points. Conclusion:Fetal MRI signs and predictive integration model can effectively identify the presence or absence of hernia sacs in fetuses with congenital diaphragm hernia, which has certain clinical significance.

Natural evolution of perforating wounds of 30% extension of the left diaphragm and the anatomopathological characteristics of its healing. Experimental Study / Evolução natural das feridas perfurocortantes de 30% de extensão do diafragma esquerdo e das características anatomopatológicas de sua cicatrização. Estudo Experimental

ABSTRACT Introduction: diaphragmatic injury is a challenge for surgeons. It is an injury that can be isolated. It is frequent in penetrating thoracoabdominal trauma. It represents a diagnostic challenge and the ideal approach is not yet well established. The occurrence of spontaneous healing of these injuries is still much discussed and even more, if it does, what is the healing mechanism? Objective: to macroscopically and histologically evaluate the natural evolution of perforation and cutting wounds equivalent to 30% of the left diaphragm. Method: 50 specimens of rats underwent a surgical procedure and, after 30 days, were euthanized and those that presented scar tissue in the diaphragm, the samples were submitted to histopathological study, using the hematoxylin and eosin stains, Massons trichrome and Picrosirius to assess the presence of collagen or muscle fibers (hyperplasia) in the scar. Results: it was found that healing occurred in diaphragmatic injuries in 90% of rats. We also observed the presence of fibrosis in all analyzed samples. Conclusion: Spontaneous healing occurred in most diaphragmatic injuries and the inflammatory reaction represented by the presence of fibrosis and collagen deposition was observed in all our samples. Muscle fiber hyperplasia did not occur.

RESUMO Introdução: o ferimento diafragmático é um desafio para os cirurgiões. É uma lesão que pode ser isolada. É frequente nos traumas penetrantes toracoabdominais. Representa um desafio diagnóstico e a conduta ideal ainda não está bem estabelecida. A ocorrência da cicatrização espontânea dessas lesões é ainda muito discutida e mais ainda, se ocorre, qual o mecanismo de cicatrização? Objetivo: avaliar macroscopicamente e histologicamente a evolução natural das feridas perfuro cortantes equivalentes a 30% do diafragma esquerdo. Método: 50 espécimes de ratos, foram submetidos a procedimento cirúrgico e, após 30 dias, foram submetidos à eutanásia e aqueles que apresentaram tecido cicatricial no diafragma, as amostras foram submetidas a estudo histopatológico, usando as colorações de hematoxilina e eosina, tricrômico de Masson e Picrossirius para avaliar a presença de colágeno ou de fibras musculares (hiperplasia) na cicatriz. Resultados: verificou-se que ocorreu nas lesões diafragmáticas, a cicatrização em 90% dos ratos. Observamos também, a presença de fibrose em todas as amostras analisadas. Conclusão: ocorreu cicatrização espontânea na maioria das lesões diafragmáticas e a reação inflamatória representada pela presença de fibrose e deposição de colágeno foi observada em todas as nossas amostras. Não ocorreu hiperplasia de fibras musculares.

Acquired diaphragmatic hernia after hepatectomy and liver transplantation in adults and children: A case series and literature review.

BACKGROUNDS/AIMS: Acquired diaphragmatic hernia is a rare complication following liver surgery in adult and pediatric patients. This study aims to describe main features occurring in adult and pediatric patients after liver surgery and report an up-date review of the literature. METHODS: All adult and pediatric patients who were diagnosed with postoperative acquired diaphragmatic hernia in Lyon and Marseille University Hospitals were included in this study. Diagnosis, clinical, radiologic, and therapeutic data were analysed retrospectively from medical papers and/or electronic records. RESULTS: Thirteen adults with a median age of 50 years (range, 30-67 years) and 5 children aged 2.4 years (range, 0.9-4 years) were diagnosed with acquired diaphragmatic hernia after a median time of 65.1 (range, 1.8-244.7) and 2 (range, 0.33-10.9) months, respectively, following surgeries (5 live-donor right hepatectomies, 5 right and 1 left hepatectomies for tumors and cysts, and 2 whole liver transplantations in adults; and 5 liver transplantations with left lateral section in children). Eleven patients presented digestive and/or thoracic symptoms whereas seven were asymptomatic and diagnosed by routine imaging follow-up. All patients were re-operated with a median delay of 2.4 months (range, 0-25.3 months) for adults and 1 day (range, 0-2 days) for children. Two recurrences resulted in a secondary surgical repair. CONCLUSIONS: Acquired diaphragmatic hernia is a rare and potentially serious event after liver surgery. Recognition and surgical repair of this particular complication should be considered in the setting of unexplained abdominal and/or thoracic symptoms. Preventive measures should be taken intraoperatively.

Diagnostic performance of multislice computed tomography to detect diaphragmatic injuries in hemodynamically stable patients. Preliminary results / Rendimiento diagnóstico de la tomografía computarizada multidetector para la identificación de heridas diafragmáticas en pacientes hemodinámicamente estables. Resultados preliminares

Abstract Introduction: Diaphragmatic injuries are a common finding in patients with penetrating thoracoabdominal trauma. Their diagnosis requires exploration through open or laparoscopic surgery. However, multislice computed tomography (MSCT) emerges as a useful noninvasive tool for this purpose. Objective: To determine the diagnostic performance of MSCT for detecting diaphragmatic injuries in hemodynamically stable patients with penetrating thoracoabdominal trauma. Materials and methods: Prospective study conducted on 119 patients treated at the Hospital Universitario del Valle, Cali, Colombia, between March 2012 and June 2015. In order to evaluate the diagnostic performance of MSCT, the results obtained through this test were compared with those reported in the reference test (open surgery). Two readings of the imaging studies were performed by 2 radiologists. Intra- and interobserver agreement on the MSCT readings were analyzed using the Fleiss' Kappa coefficient. Results: MSCT had sensitivity and specificity of 94.4% and 46.8%, respectively. Its positive (PPV) and negative (NPV) predictive values were 44.7% and 94.8%, respectively. The positive likelihood ratio (LR+) was 1.7765, and the negative likelihood ratio (LR-) was 0.1186. Regarding interobserver agreement, Fleiss' Kappa coefficient between the first reading of both radiologists was 0.4425. Conclusions: MSCT specificity for diagnosing diaphragmatic injuries found in this study differs considerably from that reported in the literature. Considering the sensitivity, PPV and LR- values obtained in the present study, MSCT could be an important tool for the management of these patients since conservative treatment may be used in patients whose diaphragmatic injuries are not detected with this type of scan.

Resumen Introducción. Las heridas diafragmáticas son un hallazgo común en pacientes con trauma toracoabdominal penetrante. Su diagnóstico requiere exploración mediante cirugía abierta o laparoscópica. Sin embargo, la tomografía computarizada multidetector (TCMD) surge como una herramienta no invasiva útil para este propósito. Objetivo. Determinar el rendimiento diagnóstico de la TCMD en la identificación de heridas diafragmáticas en pacientes con trauma toracoabdominal penetrante hemodinámicamente estables. Materiales y métodos. Estudio prospectivo realizado en 119 pacientes atendidos en el Hospital Universitario del Valle, Cali, Colombia, entre marzo de 2012 y junio de 2015. Para evaluar el rendimiento diagnóstico de la TCMD, los resultados obtenidos mediante esta prueba fueron comparados con los reportados por el test de referencia (cirugía abierta). Se realizaron 2 lecturas de los estudios de imagen por 2 radiólogos. La concordancia intra e interobservador respecto a la lectura de las TCMD se analizó mediante el coeficiente Kappa de Fleiss. Resultados. La TCDM tuvo una sensibilidad y especificidad de 94.4% y 46.8%, respectivamente. Sus valores predictivos positivo (VPP) y negativo (VPN) fueron 44.7% y 94.8%, respectivamente. La razón de verosimilitud positiva (LR+) fue 1.7765, y la razón de verisimilitud negativa (LR-), 0.1186. Respecto a la concordancia interobservador, el coeficiente Kappa de Fleiss entre la primera lectura de ambos radiólogos fue de 0.4425. Conclusiones. La especificidad de la TCMD para el diagnóstico de heridas diafragmáticas encontrada en el presente estudio difiere considerablemente de lo reportado en la literatura. Teniendo en cuenta la sensibilidad, el VPN y la LR- obtenidos en el presente estudio, la TCMD podría constituir una herramienta importante en el manejo de estos pacientes, ya que en aquellos en los que no se detecte herida diafragmática mediante este tipo de tomografía podría considerarse un manejo conservador.

Research advances in diaphragmatic hernia after thermal ablation for primary liver cancer / 临床肝胆病杂志

Thermal ablation, including radiofrequency ablation and microwave ablation, is a frequently used method for local treatment of primary liver cancer with a marked clinical effect, and it has been widely used in clinical practice in recent years. Diaphragmatic hernia is a rare complication of thermal ablation, but its incidence rate tends to gradually increase in recent years. This article reviews the cases of diaphragmatic hernia after thermal ablation for primary liver cancer in China and globally and elaborates on possible risk factors, diagnosis and treatment, and prevention strategies, so as to improve the understanding of diaphragmatic hernia after thermal ablation for primary liver cancer among clinicians and achieve the goal of preoperative prevention, rapid diagnosis and intervention, and reduced mortality rate.

Manejo laparoscópico de hernia diafragmática traumática: reporte de un caso / Laparoscopic management of traumatic diaphragmatic hernia: a case report

La hernia diafragmática traumática representa un reto al momento del diagnóstico. Una detección oportuna permite establecer un correcto tratamiento quirúrgico. Se presenta el caso de un paciente masculino de 37 años de edad con antecedente de trauma torácico por arma blanca 4 años antes; quien acude por cuadro de dolor abdominal intenso localizado en epigastrio que se irradia a hipocondrio izquierdo de aparición súbita 72 horas antes de su ingreso. Al examen físico murmullo vesicular disminuido en campo pulmonar izquierdo, y abdomen doloroso a la palpación a nivel de epigastrio e hipocondrio izquierdo. En exámenes de laboratorio no se evidencian alteraciones, mientras que la tomografía reporta hernia diafragmática izquierda; la misma que fue resuelta quirúrgicamente mediante técnica laparoscópica.

Traumatic diaphragmatic hernia represents a challenge at diagnosis. A timely detection allows to establish a correct surgical treatment. It is presented the case of a 37-year-old male patient with a history of stabbing chest trauma 4 years earlier; who comes for symptoms of intense abdominal pain located in the epigastrium that radiates to the left hypochondrium of sudden onset 72 hours before admission. On physical xamination, vesicular murmur decreased in the left lung field, and a painful abdomen on palpation at the level of the epigastrium and left hypochondrium were showed. Laboratory tests did not show any alterations, but tomography reports a left diaphragmatic hernia; this one was solved surgically by laparoscopic technique.

Long-term outcomes following surgical repair of giant paraoesophageal hiatus hernia.

INTRODUCTION: There are limited data regarding long-term outcomes after surgical repair of giant paraoesophageal hiatus hernia (GPHH). The aim of this study was to assess symptomatic recurrence and patient-reported outcomes following GPHH repair. METHODS: 178 patients undergoing elective (127) and emergency (51) GPHH repair between 1994 and 2015 were identified from the prospectively collected Lothian Surgical Audit database. Electronic patient records were used to determine rate of clinical recurrence. A postal questionnaire was used to assess modified DeMeester, 'Gastrointestinal Symptom Rating Scale' symptom scores, breathing and exercise tolerance, and patient satisfaction. RESULTS: Median follow-up was 35 months (range 12-238). 15 (8.4%) patients developed a clinical recurrence and 13 (7.3%) underwent a further operation. The clinical recurrence rates were similar in patients followed-up less than 5 years and beyond 5 years [10/128 (7.8%) vs 5/50 (10%)]. Mortality rate was 1.6% for elective compared with 16.7% for emergency procedures (P < 0.001). Completed questionnaires were received from 95 (78.5%) of 121 eligible patients. Mean symptom scores were low (Modified DeMeester 2.6). 83.7% of patients reported a good or excellent outcome, and 97.8% believed they had made the correct decision to undergo surgery. CONCLUSIONS: Surgical repair of GPHH is associated with high levels of patient satisfaction and good overall symptom outcome. There is a clinical recurrence rate of 8.4%, which does not significantly increase with long-term follow-up.

An Unexpected Adverse Event during Colonoscopy Screening: Bochdalek Hernia.

Bochdalek hernia (BH) is defined as herniated abdominal contents appearing throughout the posterolateral segment of the diaphragm. It is usually observed during the prenatal or newborn period. Here, we report a case of an adult patient with herniated omentum and colon due to BH that was discovered during a colonoscopy. A 41-year-old woman was referred to our hospital with severe left chest and abdominal pain that began during a colonoscopy. Her chest radiography showed colonic shadow filling in the lower half of the left thoracic cavity. A computed tomography scan revealed an approximately 6-cm-sized left posterolateral diaphragmatic defect and a herniated omentum in the colon. The patient underwent thoracoscopic surgery, during which, the diaphragmatic defect was closed and herniated omentum was repaired. The patient was discharged without further complications. To the best of our knowledge, this case is the first report of BH in an adult found during a routine colonoscopy screening.

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis

Abstract Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent. Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software. Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%). Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.

Effect and significance of tetrandrine on expression of Rho/Rho kinase in fetal lung of congenital diaphragmatic hernia rats / 重庆医学

Objective To investigate the effect and significance of the traditional Chinese medicine tetrandrine(TET) prenatal intervention on the expression of RhoA protein and Rho kinase ROCK1 in the fetal lung of congenital diaphragmatic hernia (CDH) rat model.Methods SD female rats with 9.5 d of gestation were randomly divided into the control group,CDH group and TET group.The CDH group and TET intervention group were administered with nitrofen by gavage for establishing CDH model.The TET intervention was given on 16.5 d of gestation.The fetal rat lungs were taken by cesarean section on 21.5 d of gestation and the lung weight/body ratio(Lw/Bw) was measured.The lung development and small pulmonary arterial morphologic changes in HE staining in all groups were observed with microscopy.The protein expression of RhoA and Rho kinase ROCK1were respectively examined by immunohistochemistry and Western blot.Results In the CDH group,the lungs had obvious maldevelopment and the fetal lung development in the TET group was close to that in the control group.The lung development indicators of Lw/Bw,PAA％,and lung vascular remodeling indicators of lumen area and vascular total area ratio(LA％) in the CDH group were significantly lower than those in the control group(2.11±0.36 vs.4.24±0.31;33.60±3.12 vs.58.81 ±2.92;38.58±2.15 vs.61.20±3.23,P＜0.05),the indicators of Lw/Bw.PAA％ and LA％ after TET intervention were significantly improved compared with the CDH group(3.61±0.24 vs.2.11±0.36;42.46±3.68 vs.33.60±3.12;56.07±3.32 vs.38.58±2.15,all P ＜0.05);the ratio of small pulmonary artery wall thickness to vascular external diameter (WT％) and the medium thickness percentage (MT％) in CDH group were significantly higher than those in the control group(26.64±2.41 vs.13.50±1.45 and 25.98±2.79 vs.16.47±2.07,P＜0.05),WT％ and MT％ in the TET group were obviously lower than those in the CDH group (16.02±2.35 vs.26.64± 2.41 and 17.96 ± 1.95 vs.25.98 ± 2.79,P＜0.05).The immunohistochemistry and Western blot detection indicated that the expressions of RhoA and ROCK1 from low to high were the control group ＜TET group ＜ CDH group.Conclusion Pulmonary hypoplasia and lung vascular remodeling exist in fetal rats with CDH and Rho/Rho kinase signaling pathway may be involved in the process.Prenatally giving TET may play the lung protective effect by regulating the Rho/Rho signal pathway.

Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation / 中华普通外科杂志

Objective To explore the diagnosis and treatment of diaphragmatic hernia (DH)secondary to living donor liver transplantation (LDLT) in pediatrics.Methods The primary disease was biliary atresia and all of the 4 patients underwent LDLT using a donor's left lateral graft.The ages of recipients were 5-7 months at LDLT and the onset of DH were 1.5-16 months after LDLT.There were 3 right DH and 1 left DH,and 3 were emergency cases.Results The graft weight and graft to recipient body weight ratio (GRWR) were respectively between 170-290 g and between 2.7％-5.0％.Clinical symptoms included urgent respiratory distress,dyspepsia or gastrointestinal obstruction.DH was diagnosed by computed tomography scan or X-ray of the chest.Laparotomy were performed successfully to repair the DH including emergency laparotomy in three patients.Herniated organs were partial intestines or colon and partial stomach.All cases recovered without major complications.Conclusions DH post-LDLT is an unusual complication,often calls for emergent management.

An Unexpected Adverse Event during Colonoscopy Screening: Bochdalek Hernia / 대한소화기학회지

Bochdalek hernia (BH) is defined as herniated abdominal contents appearing throughout the posterolateral segment of the diaphragm. It is usually observed during the prenatal or newborn period. Here, we report a case of an adult patient with herniated omentum and colon due to BH that was discovered during a colonoscopy. A 41-year-old woman was referred to our hospital with severe left chest and abdominal pain that began during a colonoscopy. Her chest radiography showed colonic shadow filling in the lower half of the left thoracic cavity. A computed tomography scan revealed an approximately 6-cm-sized left posterolateral diaphragmatic defect and a herniated omentum in the colon. The patient underwent thoracoscopic surgery, during which, the diaphragmatic defect was closed and herniated omentum was repaired. The patient was discharged without further complications. To the best of our knowledge, this case is the first report of BH in an adult found during a routine colonoscopy screening.

Repair of Intrapericardial Diaphragmatic Hernia during Aortic Surgery in a 78-Year-Old Woman.

Intrapericardial diaphragmatic hernias are reported very rarely. Those of congenital origin are most often diagnosed in neonates, and those caused by indirect blunt trauma occur chiefly in adults. The latter type can be asymptomatic; however, the results of a computed tomographic scan can yield a definitive diagnosis. Once discovered, these hernias should be corrected to avoid severe sequelae such as bowel strangulation and necrosis, peritonitis, mediastinitis, and cardiac tamponade. We report the case of a 78-year-old woman who presented for elective ascending aortic aneurysm repair. Computed tomographic angiograms incidentally revealed a large intrapericardial diaphragmatic hernia, which had probably developed years earlier, after a traffic accident. The patient underwent a median sternotomy and repair of the intrapericardial diaphragmatic hernia with use of a bovine pericardial patch, followed by ascending aortic and hemiarch repair, aortic valve repair, and aorto-right coronary artery bypass grafting. We discuss the details of these procedures and alternative treatment options. To our knowledge, this is the first report of concomitant aortic surgery and repair of a trauma-induced intrapericardial diaphragmatic hernia in an adult.

An Incidental Discovery of Morgagni Hernia in an Elderly Patient Presented with Chronic Dyspepsia.

A Morgagni hernia was first described in 1761 by Giovanni Morgagni. In adults, it is accompanied by gastrointestinal- or respiratory-type symptoms. Herein, we report an 84-year-old woman presented to our hospital with nausea and vomiting. After hospitalization, an X-ray revealed a right diaphragmatic hernia. Based on the results of abdominal computed tomography, duodenoscopy, and upper gastrointestinography (gastrografin), we concluded that her symptoms were caused by Morgagni hernia. Our patient underwent laparoscopic surgery, and shortly thereafter, her symptoms resolved.

Laparoscopic Treatment of Morgagni Hernia: Report of Three Cases.

We report on three cases of diaphragmatic (Morgagni) hernia with different clinical presentation. It is important to consider the possibility of this rare but potentially very dangerous condition in patients with respiratory problems and pain in the upper abdomen. Before laparoscopy, two different approaches were used in diaphragmatic hernia operations (abdominal and thoracic approach). Laparoscopy has brought significant changes in the treatment of diaphragmatic hernia. It is important to stress that laparoscopic diaphragmatic surgical therapy uses stronger mesh than the mesh used to repair an inguinal hernia.

An Incidental Discovery of Morgagni Hernia in an Elderly Patient Presented with Chronic Dyspepsia / 대한소화기학회지

A Morgagni hernia was first described in 1761 by Giovanni Morgagni. In adults, it is accompanied by gastrointestinal- or respiratory-type symptoms. Herein, we report an 84-year-old woman presented to our hospital with nausea and vomiting. After hospitalization, an X-ray revealed a right diaphragmatic hernia. Based on the results of abdominal computed tomography, duodenoscopy, and upper gastrointestinography (gastrografin), we concluded that her symptoms were caused by Morgagni hernia. Our patient underwent laparoscopic surgery, and shortly thereafter, her symptoms resolved.