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Saito T, Yasui K, Kurahashi S, Komaya K, Ishiguro S, Arikawa T, Komatsu S, Kaneko K, Miyachi M, Sano T. Intrapericardial diaphragmatic hernia into the pericardium after esophagectomy: a case report. Surg Case Rep 2018; 4:94. [PMID: 30105742 PMCID: PMC6089855 DOI: 10.1186/s40792-018-0499-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Intrapericardial diaphragmatic hernia (IPDH), defined as prolapse of the abdominal viscera into the pericardium, is a rare clinical condition. This case illustrates the possibility of IPDH after esophagectomy with antethoracic alimentary reconstruction, although such hernias are extremely rare. IPDH often presents with symptoms of bowel obstruction such as abdominal discomfort or vomiting. If not properly treated, life-threatening necrosis and/or perforation of the herniated contents may occur. Case presentation A 68-year-old Japanese man underwent subtotal esophagectomy with three-field lymph node dissection for treatment of esophageal cancer. Completion gastrectomy with perigastric lymph node dissection was also performed because the patient had previously undergone distal partial gastrectomy for treatment of gastric cancer. The alimentary continuity was reconstructed using the pedicled jejunal limb through the antethoracic route. When we separated the diaphragm from the esophagus and removed xiphoid surgically to prevent a pedicled jejunal limb injury, the pericardium was opened. The patient was readmitted to our hospital because of abdominal discomfort and vomiting 6 months after the esophagectomy. A diagnosis of IPDH after esophagectomy was made. The patient was treated by primary closure of the diaphragmatic defect using vertical mattress sutures and additional reinforcement of the closing defect using a graft harvested from the rectus abdominis posterior sheath. The postoperative course was uneventful, and he was discharged on the seventh day after hernia repair. Conclusions This patient’s clinical course provides two important clinical suggestions. First, we must be aware of the possibility of iatrogenic IPHD after esophagectomy with antethoracic alimentary reconstruction. Second, a graft from the rectus abdominis posterior sheath is beneficial in the treatment of IPDH.
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Affiliation(s)
- Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Kohei Yasui
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenichi Komaya
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Seiji Ishiguro
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masahiko Miyachi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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D'Orio V, Demondion P, Lebreton G, Coutance G, Varnous S, Leprince P. Acquired transdiaphragmatic hernia: an unusual cause of cardiac tamponade. Asian Cardiovasc Thorac Ann 2017; 25:233-236. [PMID: 28325075 DOI: 10.1177/0218492317698326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transdiaphragmatic peritoneopericardial hernia is a rare complication after peritoneopericardial window formation, coronary artery bypass grafting using the gastroepiploic artery, or subxiphoid epicardial pacemaker insertion. We describe two different clinical presentations of transdiaphragmatic peritoneopericardial hernia in patients who had undergone recent heart transplantation. One was an exceptional case of cardiac tamponade caused by small bowel strangulation through a diaphragmatic defect.
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Affiliation(s)
- Virginie D'Orio
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
| | - Pierre Demondion
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
| | - Guillaume Coutance
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
| | - Sheida Varnous
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, La Pitié Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France
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3
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Inoue S, Odaka A, Muta Y, Beck Y, Sobajima H, Tamura M. Coexistence of congenital diaphragmatic hernia and abdominal wall closure defect with chromosomal abnormality: two case reports. J Med Case Rep 2016; 10:19. [PMID: 26800685 PMCID: PMC4724109 DOI: 10.1186/s13256-016-0805-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/06/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND We reported two rare cases of congenital diaphragmatic hernia with abdominal wall closure defect, which were not associated with septum transversum diaphragmatic defects or Fryns syndrome. CASE PRESENTATION Case 1: a Japanese baby boy was delivered at 37 weeks' gestation by urgent cesarean section because of the diagnosis of severe fetal distress. Congenital diaphragmatic hernia with omphalocele was prenatally diagnosed with fetal ultrasound. A ruptured omphalocele was confirmed at delivery. A silo was established on the day of his birth; direct closure of his diaphragmatic defect and abdominal wall closure was performed on the fifth day after his birth. Trisomy 13 was confirmed by genetic examination. His postoperative course was uneventful and he was discharged 5 months postnatally with home oxygen therapy. He was readmitted because of heart failure and died at 6 months. Case 2: a Japanese baby boy, who was prenatally diagnosed with gastroschisis, was delivered at 35 weeks' gestation by urgent cesarean section because of the diagnosis of fetal distress. Silo construction using a wound retractor was performed on the day of his birth and direct abdominal closure was performed on the tenth day after his birth. Trisomy 21 was confirmed by genetic examination. Treatment for his respiratory distress was continued after surgery. A retrosternal hernia was revealed at 6 months and direct closure of retrosternal diaphragm with the resection of hernia sac was performed. His postoperative course was uneventful and he was discharged with home oxygen therapy. CONCLUSIONS Attention should be paid to chromosomal abnormality in cases in which the coexistence of congenital diaphragmatic hernia and abdominal wall closure defect are observed.
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Affiliation(s)
- Seiichiro Inoue
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan.
| | - Akio Odaka
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan
| | - Yuki Muta
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan
| | - Yoshifumi Beck
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan
| | - Hisanori Sobajima
- Department of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan
| | - Masanori Tamura
- Department of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe, Saitama, 3508550, Japan
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4
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Lehman AM, Cowan JR, McFadden DE, Patel MS. Anterolateral diaphragmatic hernia with body wall defect understood in relation to the abaxial domain. Am J Med Genet A 2014; 164A:1860-2. [PMID: 24700809 DOI: 10.1002/ajmg.a.36529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/14/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Anna M Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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5
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Bean JF, Kort CA, Radhakrishnan J. Concurrent congenital peritoneopericardial diaphragmatic hernia and bochdalek hernia in a neonate. SPRINGERPLUS 2014; 3:290. [PMID: 25019041 PMCID: PMC4074462 DOI: 10.1186/2193-1801-3-290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/30/2014] [Indexed: 11/10/2022]
Abstract
We present the first report of a neonate with, concurrent left sided Bochdalek hernia and peritoneopericardial diaphragmatic hernia.
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Affiliation(s)
- Jonathan F Bean
- Resident in Surgery, Division of Pediatric Surgery, Department of Surgery, University of Illinois, Chicago, IL USA
| | - Chad A Kort
- Ex-resident in Surgery, Division of Pediatric Surgery, Department of Surgery, University of Illinois, Chicago, IL USA
| | - Jayant Radhakrishnan
- Professor Emeritus of Surgery & Urology, Division of Pediatric Surgery, Department of Surgery, University of Illinois, 1502 71st Street, Darien, IL 60561 USA
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6
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Park CW, Pryor AD. Laparoscopic repair of a large pericardial hernia. Surg Endosc 2013; 27:2971-3. [PMID: 23404150 DOI: 10.1007/s00464-013-2820-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Chan W Park
- Duke University Health System, Durham, NC, USA.
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7
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Scahill MD, Maak P, Kunder C, Halamek LP. Anterolateral congenital diaphragmatic hernia with omphalocele: A case report and literature review. Am J Med Genet A 2013; 161A:585-8. [DOI: 10.1002/ajmg.a.35703] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 09/01/2012] [Indexed: 11/08/2022]
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8
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Ackerman KG, Vargas SO, Wilson JA, Jennings RW, Kozakewich HP, Pober BR. Congenital diaphragmatic defects: proposal for a new classification based on observations in 234 patients. Pediatr Dev Pathol 2012; 15:265-74. [PMID: 22257294 PMCID: PMC3761363 DOI: 10.2350/11-05-1041-oa.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Congenital diaphragmatic defects (CDDs) are a common group of birth defects, yet we presently know little about their pathogenesis. No systematic study documenting the detailed morphology of CDD has been performed, and current classification schemata of diaphragm phenotypes incompletely capture the location and extent of diaphragmatic involvement. To define the range of CDD anatomy, diaphragmatic pathology was reviewed from an examination of 181 autopsy records of children with CDDs at Children's Hospital Boston between 1927 and 2006. Defects were classified according to several parameters, including type (communicating versus noncommunicating) and location (anterior, posterior, etc.). The information permitted development of a phenotyping worksheet for prospective use on patients undergoing diaphragmatic repair at Children's Hospital Boston or MassGeneral Hospital for Children. Fifty-three patients who died between 1990 and 2006 had a total of 63 defects. Thirty-nine had a "classic" CDD phenotype (64% posterolateral, 18% hemidiaphragmatic aplasia, and 18% anterior). The remaining 19 defects, not fitting classical descriptions, were located in the posteromedial, anterolateral, or lateral regions of the diaphragm. Prospective data collected during surgical repair revealed posterolateral defects in 34 of 41 cases that demonstrated wide phenotypic variability in size, location, shape, type, and extent of organ displacement. Congenital diaphragmatic defects display significant phenotypic variation. Because rigorous anatomic evaluation and documentation are important steps towards elucidating the developmental biology of these disorders, we suggest establishment of a new and more precise classification using the model presented herein.
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Affiliation(s)
- Kate G. Ackerman
- Center for Pediatric Biomedical Research, University of Rochester, Rochester, NY, USA
,Department of Pediatrics (Division of Critical Care) and Department of Biomedical Genetics, University of Rochester, Rochester, NY, USA
,Corresponding author,
| | - Sara O. Vargas
- Harvard Medical School, Boston, MA, USA
,Department of Pathology, Children’s Hospital, Boston, MA, USA
| | - Jay A. Wilson
- Harvard Medical School, Boston, MA, USA
,Department of Surgery, Children’s Hospital, Boston, MA, USA
| | - Russell W. Jennings
- Harvard Medical School, Boston, MA, USA
,Department of Surgery, Children’s Hospital, Boston, MA, USA
| | - Harry P.W. Kozakewich
- Harvard Medical School, Boston, MA, USA
,Department of Pathology, Children’s Hospital, Boston, MA, USA
| | - Barbara R. Pober
- Harvard Medical School, Boston, MA, USA
,Department of Surgery, Children’s Hospital, Boston, MA, USA
,Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
,Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA, USA
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9
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Jagad RB, Kamani P. Central diaphragmatic hernia in an adult: a rare presentation. Hernia 2011; 16:607-9. [DOI: 10.1007/s10029-011-0800-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Affiliation(s)
- R B Jagad
- N M Virani Wockhardt Hospital, Kalawad Road, Rajkot, Gujarat 360007, India.
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10
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Drafts BC, Chughtai HL, Entrikin DW. Iatrogenic intrapericardial diaphragmatic hernia diagnosed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:3. [PMID: 20064206 PMCID: PMC2817870 DOI: 10.1186/1532-429x-12-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/08/2010] [Indexed: 11/30/2022] Open
Abstract
Intrapericardial diaphragmatic hernias are very uncommon and are most typically caused by high-force blunt trauma. Other iatrogenic causes such as prior surgical formation of a pericardial window have been described, but are exceedingly rare. We present a case of an intrapericardial diaphragmatic hernia in a patient with a prior pericardial window in which the diagnosis was unclear using conventional imaging modalities, but was established using cardiovascular magnetic resonance.
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Affiliation(s)
- Brandon C Drafts
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Haroon L Chughtai
- Department of Cardiology, Saint Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
| | - Daniel W Entrikin
- Departments of Radiology and Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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11
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Abstract
The original description by Morgagni of the anterior diaphragmatic defect that bears his name implies a paramedian defect and this may be true when acquired in adulthood. In contrast, the anterior diaphragmatic defect that is observed in children is central rather than paramedian, as is often assumed. Its central retrosternal location has been confirmed by various methods, but is most clearly evident on laparoscopy.
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Affiliation(s)
- Craig A McBride
- Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
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12
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A case of congenital diaphragmatic hernia with a hernia sac attached to the liver: hints for an early embryological insult. J Pediatr Surg 2007; 42:1761-3. [PMID: 17923211 DOI: 10.1016/j.jpedsurg.2007.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe here the unusual operative findings in a case of congenital diaphragmatic hernia (CDH). A neonate antenatally diagnosed as having CDH was operated via a left subcostal incision. The operative findings included a large central diaphragmatic defect of 5 x 5 cm, lined by a thick sac. The contents of the hernia included the stomach, spleen, and loops of the small and large intestine. The left side of the liver was thinned out and forming a part of the dome of the sac of the CDH. Vessels of the hepatic tissue were in continuity with the sac. There were scattered liver tissues forming cords in the sac lining. These findings were confirmed by histopathologic examinations. These findings have not been reported earlier in humans and might help to elucidate the embryology of the development of the diaphragm. Our findings suggest that this kind of defect occurs early in development, and we hypothesize that it is associated with a poorer prognosis.
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13
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Ackerman KG, Greer JJ. Development of the diaphragm and genetic mouse models of diaphragmatic defects. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 145C:109-16. [PMID: 17436296 DOI: 10.1002/ajmg.c.30128] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Improving our understanding of diaphragmatic development is essential to making progress in defining the pathogenesis and genetic etiologies of congenital diaphragmatic defects in humans. As mouse genetic technology has given us new tools to manipulate and observe development, a number of mouse models have recently emerged that provide valuable insight to this field. In this article, we review our current understanding of diaphragmatic embryogenesis including the origin of diaphragmatic tissue. We use rodent models to review the muscularization of the diaphragm and review selected genetic models of abnormal muscularization. We also review models of posterior diaphragmatic defects and discuss evidence for the pleuroperitoneal fold (PPF) tissue contributing to the diaphragm. Finally, we discuss models of anterior and central hernias. It may be simplistic to subdivide this review based on anatomic regions of the diaphragm, as evidence is emerging that defects in different regions of the diaphragm in humans and in mice may be etiologically related. However, at this time we do not have enough knowledge to make more mechanistic or genetic classifications though with time, genetic progress in the field of diaphragm development will allow us to do this.
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Affiliation(s)
- Kate G Ackerman
- Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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14
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Paci M, de Franco S, Della Valle E, Ferrari G, Annessi V, Ricchetti T, Sgarbi G. Septum transversum diaphragmatic hernia in an adult. J Thorac Cardiovasc Surg 2005; 129:444-5. [PMID: 15678061 DOI: 10.1016/j.jtcvs.2004.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Massimiliano Paci
- Division of Thoracic Surgery, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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15
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Murari VJ, Alexander GL, Cassivi SD. Massive intrapericardial herniation of stomach following pericardial window. Hernia 2004; 8:273-6. [PMID: 14735328 DOI: 10.1007/s10029-003-0202-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Accepted: 12/09/2003] [Indexed: 10/26/2022]
Abstract
Herniation of intra-abdominal contents into the pericardial cavity is rare. We describe one such case occurring after creation of a pericardioperitoneal window for drainage of a pericardial effusion. The diagnosis of an intrapericardial hernia should be considered in patients presenting with gastrointestinal and/or cardiorespiratory symptoms following surgical procedures involving the diaphragm.
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Affiliation(s)
- V J Murari
- Division of Gastroenterology, Hepatology Department of Internal Medicine, Mayo Clinic, Rochester, Minn., USA
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16
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Yuan W, Rao Y, Babiuk RP, Greer JJ, Wu JY, Ornitz DM. A genetic model for a central (septum transversum) congenital diaphragmatic hernia in mice lacking Slit3. Proc Natl Acad Sci U S A 2003; 100:5217-22. [PMID: 12702769 PMCID: PMC154325 DOI: 10.1073/pnas.0730709100] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2002] [Accepted: 02/05/2003] [Indexed: 01/13/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a significant cause of pediatric mortality in humans with a heterogeneous and poorly understood etiology. Here we show that mice lacking Slit3 developed a central (septum transversum) CDH. Slit3 encodes a member of the Slit family of guidance molecules and is expressed predominantly in the mesothelium of the diaphragm during embryonic development. In Slit3 null mice, the central tendon region of the diaphragm fails to separate from liver tissue because of abnormalities in morphogenesis. The CDH progresses through continuous growth of the liver into the thoracic cavity. This study establishes the first genetic model for CDH and identifies a previously unsuspected role for Slit3 in regulating the development of the diaphragm.
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Affiliation(s)
- Wenlin Yuan
- Department of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, MO 63110, USA
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17
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Affiliation(s)
- Ronald Y Chin
- Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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18
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Vazquez-Jimenez JF, Muehler EG, Daebritz S, Keutel J, Nishigaki K, Huegel W, Messmer BJ. Cantrell's syndrome: a challenge to the surgeon. Ann Thorac Surg 1998; 65:1178-85. [PMID: 9564963 DOI: 10.1016/s0003-4975(98)00089-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We present a case of partial Cantrell's syndrome with ventricular septal defect, left ventricular diverticulum, dextrorotation of the heart, an anterior diaphragmatic defect, and a midline supraumbilical abdominal wall defect with omphalocele. At the age of 20 months, the patient underwent a successful cardiac surgical procedure. To detect risk factors and to define therapeutic strategies, we analyzed the spectrum and the frequency of malformations described in 153 patients with Cantrell's syndrome. Despite modern surgical standards, Cantrell's syndrome represents a challenge to the surgeon because of the wide spectrum of anomalies, the severity of the abdominal and cardiac malformations, and the high mortality.
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Affiliation(s)
- J F Vazquez-Jimenez
- Thoracic and Cardiovascular Surgery and Pediatric Cardiology, Rheinisch-Westfälische-Technische Hochschule Aachen, Germany
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19
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Martin RA, Cunniff C, Erickson L, Jones KL. Pentalogy of Cantrell and ectopia cordis, a familial developmental field complex. AMERICAN JOURNAL OF MEDICAL GENETICS 1992; 42:839-41. [PMID: 1554024 DOI: 10.1002/ajmg.1320420619] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The association of sternal fusion defects with various cardiac, diaphragmatic, and anterior body wall defects represents a developmental field complex that includes the Pentalogy of Cantrell and ectopia cordis. No familial cases have been reported previously. We present 3 consecutively born brothers with extensive diaphragmatic defects, 2 who had the Pentalogy of Cantrell. One of the 2 also had ectopia cordis.
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Affiliation(s)
- R A Martin
- Department of Pediatrics, University of California, San Diego
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20
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Abstract
Unusual varieties of diaphragmatic herniae can be classified into two major groups, congenital and acquired. The late-presenting Bochdalek herniae often present difficulties in diagnosis which may lead to inappropriate treatment. The prime example is the herniated stomach, which is mistaken for a tension pneumothorax. Strangulation is a rare, but an important, complication of Bochdalek herniae. A number of techniques for closure of large diaphragmatic defects are described with recommendation of those procedures which can be performed rapidly and effectively in a critically ill infant. The literature concerning eventration is confusing due to different definitions of the condition by different authors. It may be difficult to distinguish preoperatively between this condition and congenital diaphragmatic hernia with a sac. Such distinction is often not important as the decision for intervention is based on evaluation of clinical and radiological considerations. The majority of Morgagni herniae are asymptomatic and only rarely does strangulation supervene. There is a small group of infants with Morgagni hernias who present in early infancy with respiratory symptoms. Paralysis of the diaphragm due to phrenic nerve palsy recovers spontaneously in the majority of patients. The selective use of diaphragmatic plication for this condition is widely accepted, but the decision and appropriate timing for surgical intervention is often difficult. The results of surgery are very good both in the early postoperative period and also on long-term follow-up. The diagnosis of traumatic diaphragmatic hernia is often overlooked in the presence of other major injuries. The danger of strangulation of contents of this hernia is ever present and repair should be undertaken without delay once the diagnosis is made.
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Affiliation(s)
- K B Stokes
- Children's Specialist Centre, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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21
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Westra SJ, Foglia R, Smith JB, Boechat MI. Omphalocele associated with intrapericardial diaphragmatic hernia. Pediatr Radiol 1991; 21:525-6. [PMID: 1771123 DOI: 10.1007/bf02011732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S J Westra
- Department of Radiological Sciences, UCLA Medical Center
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Milne LW, Morosin AM, Campbell JR, Harrison MW. Pars sternalis diaphragmatic hernia with omphalocele: a report of two cases. J Pediatr Surg 1990; 25:726-30. [PMID: 2380888 DOI: 10.1016/s0022-3468(05)80006-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A rare type of congenital diaphragmatic hernia occurs in which there is a large opening in the anterior diaphragm between the pericardial and peritoneal cavities without a sac. This hernia is invariably associated with defects in the anterior abdominal wall and with sternal defects. More commonly, it is associated with cardiac anomalies as in the Pentalogy of Cantrell. The etiology of this hernia is undoubtedly different from the more common hernia of Morgangni, which has a sac and few associated anomalies. The etiology may be failure of fusion of the pars sternis area of the septum transversum. Only five other cases have been described.
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Affiliation(s)
- L W Milne
- Department of Surgery, School of Medicine, Oregon Health Sciences University, Portland 97201
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García-Aranda A, Arazo Garcés P, Samperiz Legarre P, Ramos Paesa C, Bello Dronda S, Hernández Caballero A, Muñoz y Fernández J. Insuficiencia respiratoria hipercapnica como primera manifestacion de una hernia de bochdalek en el adulto. Arch Bronconeumol 1988. [DOI: 10.1016/s0300-2896(15)31799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Congenital diaphragmatic hernia continues to be a critical problem in neonatal surgery. Despite the apparent simplicity of the anatomic defect, the physiology is complex, and survival remains uncertain. Surgical success has been achieved, but we recognize that the barrier to survival is pulmonary parenchymal and vascular hypoplasia as well as the complex syndrome of persistent fetal circulation. In many ways the problem of diaphragmatic hernia is as much of an enigma to today's physician-scientist as it was to Bochdalek in the nineteenth century. The treatment of respiratory distress after repair of congenital diaphragmatic hernia has brought out the most creative and innovative efforts of pediatric surgeons in both the laboratory and the intensive care unit.
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MESH Headings
- Animals
- Cardiopulmonary Bypass
- Diaphragm/anatomy & histology
- Female
- Hernia, Diaphragmatic/diagnosis
- Hernia, Diaphragmatic/embryology
- Hernia, Diaphragmatic/mortality
- Hernia, Diaphragmatic/physiopathology
- Hernia, Diaphragmatic/surgery
- Hernias, Diaphragmatic, Congenital
- Humans
- Hypoxia/etiology
- Hypoxia/therapy
- Infant, Newborn
- Intubation, Gastrointestinal
- Lung/abnormalities
- Methods
- Persistent Fetal Circulation Syndrome/complications
- Postoperative Care
- Postoperative Complications/epidemiology
- Postoperative Complications/mortality
- Pregnancy
- Prenatal Diagnosis
- Preoperative Care
- Respiration, Artificial
- Respiratory Insufficiency/etiology
- Respiratory Insufficiency/therapy
- Vasodilator Agents/therapeutic use
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