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Rameni DA, Worrell SG. Reconstructive Techniques for Diaphragm Resection. Thorac Surg Clin 2024; 34:127-131. [PMID: 38705660 DOI: 10.1016/j.thorsurg.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A variety of diaphragmatic and non-diaphragmatic pathologies may require resection, reconstruction, or repair of the diaphragm. Adequate reconstruction is crucial in cases of diaphragmatic resection to prevent the herniation of abdominal organs into the chest and to maintain optimal respiratory function. This article aims to provide a detailed overview of the techniques used for surgical diaphragm reconstruction, taking into account factors such as the size and location of the defect, available options for reconstructive materials, potential challenges and pitfalls, and considerations related to the recurrence or failure of the repair.
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Affiliation(s)
- Dina Al Rameni
- Divison of Cardiothoracic Surgery, Department of Surgery, University of Arizona- College of Medicine, 1501 North Campbell Avenue, Room #4302, PO Box 245071, Tucson, AZ 85724, USA. https://twitter.com/DinaSRamini
| | - Stephanie G Worrell
- Divison of Cardiothoracic Surgery, Department of Surgery, University of Arizona- College of Medicine, 1501 North Campbell Avenue, Room #4302, PO Box 245071, Tucson, AZ 85724, USA; University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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2
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Celtik U, Dokumcu Z, Ozcan C, Ergün O. A rare complication of pediatric liver transplantation: Post-transplant diaphragmatic hernia. Pediatr Transplant 2024; 28:e14749. [PMID: 38623878 DOI: 10.1111/petr.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
AIM Acquired post-transplant diaphragmatic hernia (PTDH) is a rare complication of liver transplantation (LT) in children. We aimed to present our experience in PTDH, and a possible causative background is discussed. METHODS Medical records of patients who had undergone diaphragmatic repair following LT between 2015 and 2023 were reviewed. Demographic information, details of primary diseases necessitating LT, transplantation techniques, and clinical findings associated with PTDH were evaluated. RESULTS There were seven patients with PTDH. Median age at transplantation was 69 (range: 9-200) months. Five patients received a left lateral sector, one patient had a right lobe, and one had a left lobe graft. Time between LT and PTDH was 9 (2-123) months. One patient who was diagnosed in the postoperative 10th year was asymptomatic. Respiratory distress and abdominal pain were the main symptoms among all. All patients underwent laparotomy, and primary repair was performed in six patients, and one patient required mesh repair because of a large defect. Small intestine herniated in most cases. There were two complicated cases with perforation of the stomach and colonic volvulus. There is no recurrence or long-term complications for the median 60 (20-119) month follow-up period. CONCLUSION PTDH is a rare but serious complication. Majority of symptomatic cases present within the first postoperative year, whereas some late-presenting cases may not be symptomatic. Inadvertent injury to the inferior phrenic vasculatures due to excessive use of cauterization for control of hemostasis may be a plausible explanation in those cases.
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Affiliation(s)
- Ulgen Celtik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Coskun Ozcan
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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3
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Addeo P, Artzner T, Bachellier P. Diaphragmatic hernia through the left triangular ligament after liver transplantation. J Gastrointest Surg 2024; 28:587-589. [PMID: 38583913 DOI: 10.1016/j.gassur.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Theirry Artzner
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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4
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Ramírez N, Monroig-Rivera C, De Jesús-Rojas W, Rosado E, Arciniegas Medina NJ, Cornier AS, Vélez-Bartolomei F, Johnston CE, Carlo S. Long-Term Follow-up of Untreated Adult Patients with Spondylothoracic Dysostosis (Jarcho-Levin Syndrome). J Bone Joint Surg Am 2024; 106:501-507. [PMID: 38127843 DOI: 10.2106/jbjs.23.00800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Spondylothoracic dysostosis (STD), also known as Jarcho-Levin syndrome (JLS), is a rare autosomal recessive disorder affecting the formation of the spine, characterized by a complete bilateral fusion of the ribs at the costovertebral junction, producing a "crablike" appearance of the thorax. Despite being declared a core indication for a V-osteotomy vertical expandable prosthetic titanium rib (VEPTR) expansion thoracoplasty of the posterior thorax, the natural history of STD in untreated subjects remains poorly documented. In this study, we report radiographic and pulmonary function findings and Patient-Reported Outcomes Measurement Information System (PROMIS) and 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) scores for untreated adult subjects with STD to gain insights into the natural history. METHODS We identified 11 skeletally mature, untreated subjects with STD. Findings on medical evaluation, demographics, radiographic parameters, pulmonary function, genetic testing results, PROMIS measures, and EOSQ-24 scores were assessed. RESULTS Five male and 6 female subjects (mean age, 32.3 years [range, 15 to 70 years]) with a confirmed STD diagnosis based on radiographs and genetic testing were evaluated. Mean body mass index (BMI) was 24.4 kg/m 2 (range, 18 to 38.9 kg/m 2 ), and mean thoracic height was 16 cm (range, 12 to 17 cm). Pulmonary function tests (PFTs) showed a mean forced vital capacity (FVC) of 22% of predicted, mean forced expiratory volume in 1 second (FEV1) of 24% of predicted, and FEV1/FVC ratio of 107% of predicted. The mean PROMIS dyspnea score was 40 ± 8 points (range, 27.7 to 52.1 points). The mean total EOSQ-24 score was 77.3 ± 18 points (range, 43.9 to 93.2 points). CONCLUSIONS Our study characterizes the natural history of STD in untreated subjects. We confirmed the expected restrictive pattern in pulmonary function, but interestingly, our subjects exhibited better EOSQ scores compared with those reported in neuromuscular populations. PFT results and thoracic height did not correspond to PROMIS and EOSQ scores, questioning the use of those parameters as a surgical indication. We therefore suggest that the STD diagnosis as an absolute indication for VEPTR expansion thoracoplasty surgery be reconsidered. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Norman Ramírez
- Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Carlos Monroig-Rivera
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Wilfredo De Jesús-Rojas
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Pediatrics and Basic Science, Ponce Health Science University, Ponce, Puerto Rico
| | - Edwin Rosado
- Atlantis Medical Center, Barceloneta, Puerto Rico
| | - Norma J Arciniegas Medina
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Pediatrics, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Alberto Santiago Cornier
- Department of Genetics, San Jorge Children's and Women Hospital, San Juan, Puerto Rico
- Department of Pediatrics, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Frances Vélez-Bartolomei
- Genetics Division, Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Charles E Johnston
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Simón Carlo
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Pediatrics, Mayagüez Medical Center, Mayagüez, Puerto Rico
- Department of Genetics, San Jorge Children's and Women Hospital, San Juan, Puerto Rico
- Department of Biochemistry, Ponce Health Sciences University, Ponce, Puerto Rico
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5
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Dayan D, Abu-Abeid A. Huge Diaphragmatic Hernia Following Revisional One Anastomosis Gastric Bypass. Obes Surg 2024; 34:704-705. [PMID: 38151556 DOI: 10.1007/s11695-023-07029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Danit Dayan
- Division of General Surgery, Bariatric Unit, Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St, 6423906, Tel Aviv, Israel.
| | - Adam Abu-Abeid
- Division of General Surgery, Bariatric Unit, Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St, 6423906, Tel Aviv, Israel
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6
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Rico Rodríguez F, Camargo Espitia DA, Mayoral Márquez A, Ruan Lin S, Martín Lorenzo MC. Anesthetic considerations in the perioperative management of the patient with Jarcho-Levin Syndrome. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:54-57. [PMID: 37678455 DOI: 10.1016/j.redare.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/30/2023] [Indexed: 09/09/2023]
Abstract
Jarcho-Levin syndrome is an eponym used to describe a spectrum of small thoracic skeletal dysplasias with variable involvement of vertebrae and ribs. Initially considered lethal, it is currently compatible with life in its mildest forms. Bone alterations that lead to a restrictive respiratory pattern, recurrent respiratory infections and particular phenotype, can make perioperative anesthetic management difficult. The proper assessment of the airway is of special interest because it presents predictors of a difficult airway, as well as the prevention, early diagnosis and adequate treatment of respiratory failure. We present the case of a patient with Jarcho-Levin Syndrome who underwent vertebral distraction surgery, with its most notable implications in anesthetic management.
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Affiliation(s)
- F Rico Rodríguez
- Doctorado Biomedicina, Investigación traslacional y nuevas tecnologías en salud de la Universidad de Málaga (UMA), Especialista en Medicina Familiar y Comunitaria, Residente Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain.
| | - D A Camargo Espitia
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - A Mayoral Márquez
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - S Ruan Lin
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - M C Martín Lorenzo
- FEA Anestesiología, Reanimación y Terapéutica del Dolor del Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
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7
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Islam N, Beamer SE, Wasson M. Diaphragmatic Hernia With Liver Protrusion Following Resection of Diaphragmatic Endometriosis. J Minim Invasive Gynecol 2024; 31:8-9. [PMID: 37839780 DOI: 10.1016/j.jmig.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Nadia Islam
- Mayo Clinic Alix School of Medicine (Islam), Scottsdale, Arizona.
| | - Staci E Beamer
- Mayo Clinic Department of Cardiothoracic Surgery (Dr. Beamer), Scottsdale, Arizona
| | - Megan Wasson
- Mayo Clinic Department of Medical and Surgical Gynecology (Dr. Wasson), Scottsdale, Arizona
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8
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Huang J, Xu D, Li A. Left diaphragmatic hernia complicated by laparoscopic splenectomy and azygoportal disconnection for a cirrhotic patient with hypersplenism and esophagogastric variceal bleeding. Asian J Surg 2023; 46:5957-5958. [PMID: 37690892 DOI: 10.1016/j.asjsur.2023.08.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China.
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
| | - Ao Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China
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9
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Köneş O, Akıncı O, Bulut S, Atar B, Değerli MS, Karabulut M. Repair of diaphragmatic hernias: Retrospective analysis of 70 cases. ULUS TRAVMA ACIL CER 2023; 29:1364-1367. [PMID: 38073460 PMCID: PMC10767288 DOI: 10.14744/tjtes.2023.98029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Congenital and traumatic diaphragmatic hernias (DH) can lead to respiratory and gastrointestinal complications that can be the cause of serious morbidity and mortality. In this study, we aimed to share our experience with the surgical repair of complicated or non-complicated DH. METHODS Patients who were operated on under emergency or elective conditions with the diagnosis of DH between 2009 and 2023 were analyzed retrospectively. Demographic characteristics, histories, symptoms, etiology of DH, computed tomography find-ings, surgical techniques, and postoperative outcomes of the patients were recorded. RESULTS The mean age of the cases was 51.5±18.5, and 29 were female and 41 were male. Hernia etiology was found to be con-genital (40%), traumatic (32.8%), spontaneous (14.3%), and iatrogenic (12.8%), respectively. The mean diameter of the defects was 7.3±2.76 cm (range: 3-15 cm), and 84% of the defects were on the left side. Sixty percent of the cases were treated by laparoscopic surgery and 11.4% by laparotomy. The conversion rate from laparoscopic to open was 24.3%. Dual mesh was used in 48% of the pa-tients, and primary suturing was applied in 34%. The postoperative mortality rate was 7.1%. CONCLUSION DH is an important cause of morbidity and mortality due to abdominal organ strangulation and pulmonary and cardiac complications. When a DH is diagnosed, laparoscopic or open surgery is the treatment that should be preferred.
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Affiliation(s)
- Osman Köneş
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
| | - Ozan Akıncı
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
| | - Sezer Bulut
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
| | - Burak Atar
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
| | - Mahmut Said Değerli
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
| | - Mehmet Karabulut
- Department of General Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, İstanbul-Türkiye
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10
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Cusumano C, Kansoun A, Kamga Tougoue F, de Mathelin P, Bachellier P, Addeo P. Incidence and outcomes of post-hepatectomy diaphragmatic hernia: a systematic review. HPB (Oxford) 2023; 25:1466-1474. [PMID: 37648598 DOI: 10.1016/j.hpb.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Post-hepatectomy diaphragmatic hernia is the second most common cause of acquired diaphragmatic hernia. This study aims to review the literature on this complication's incidence, treatment and prognosis. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed for all studies related to acquired diaphragmatic hernias after hepatectomy. RESULTS We included 28 studies in our final analysis, comprising 11,368 hepatectomies. The incidence of post-hepatectomy diaphragmatic hernia was 0.75% (n = 86). The most frequent type of hepatectomy performed was right hepatectomy (79%, n = 68), and the indications for liver resection were a liver donation for living donor transplantation (n = 40), malignant liver tumors (n = 13), and benign tumors (n = 11). The mean onset between liver resection and the diagnosis of diaphragmatic hernia was 25.7 months (range, 1-72 months), and the hernia was located on the right diaphragm in 77 patients (89.5%). Pain was the most common presenting symptom (n = 52, 60.4%), while six patients were asymptomatic (6.9%). Primary repair by direct suture was the most frequently performed technique (88.3%, n = 76). Six patients experienced recurrence (6.9%), and three died before diaphragmatic hernia repair (3.5%). CONCLUSION Diaphragmatic hernia is a rare complication occurring mainly after right liver resection. Repair should be performed once detected, given the not-negligible associated mortality in the emergency setting.
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Affiliation(s)
- Caterina Cusumano
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Alaa Kansoun
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Felix Kamga Tougoue
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Pierre de Mathelin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France; ICube, Université de Strasbourg, CNRS UMR 7357, Illkirch, France.
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11
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Yoshimine S, Tanaka T, Murakami J, Yamamoto N, Kurazumi H, Harada E, Hamano K. Laparoscopic-assisted thoracoscopic repair of latent traumatic diaphragmatic hernia: A case report. Asian J Endosc Surg 2023; 16:800-803. [PMID: 37586698 DOI: 10.1111/ases.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
Surgical approaches for traumatic diaphragmatic hernia include transabdominal, transthoracic, and thoracoabdominal. Selection of the optimal approach depends on the timing and organ damage, often minimally invasive approaches with laparoscopy or thoracoscopy are performed. A 47-year-old man with blunt chest trauma was diagnosed with left traumatic diaphragmatic hernia 1 month after the trauma. The prolapsed omentum was detached from the chest wall and around the hernia orifice and returned to the abdominal cavity by coordinated thoracoscopic and laparoscopic manipulations. The 4 × 2 cm herniation in the diaphragm was sutured closed from the thoracic side while preventing re-prolapse of the omentum and abdominal organs from the abdominal side. A combined thoracoscopic and laparoscopic approach can be effective in confirming organ damage, repositioning of prolapsed organs, and safe repair of the diaphragm in latent traumatic diaphragmatic hernia.
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Affiliation(s)
- Sota Yoshimine
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiki Tanaka
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Naohiro Yamamoto
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroshi Kurazumi
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Eijiro Harada
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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12
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Ohya Y, Aritome N, Hayashida S, Sasaki T, Morinaga T, Tsuji A, Inoue M, Iizaka M, Inomata Y. Right-Side Acquired Diaphragmatic Hernia in an Adult 15 Years After Living Donor Liver Transplant. EXP CLIN TRANSPLANT 2023; 21:537-539. [PMID: 37455473 DOI: 10.6002/ect.2023.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Cases of adult liver transplant recipients with a postoperative right-side acquired diaphragmatic hernia are extremely rare. In this report, we describe an adult case of right-side acquired diaphragmatic hernia 15 years after living donor liver transplant. A 27-year-old woman was diagnosed with pancreatic insulinoma with multiple metastases in the liver. To treat the liver failure, she underwent left lobe living donor liver transplant and distal pancreatectomy with splenectomy 3 years after the transcatheter arterial chemoembolization. As a result of the liver abscesses that reached the diaphragm, the delicate diaphragm was injured, which required repair during the transplant surgery. At the age of 46 years, she developed a cough and intermittent abdominal pain. One month later, she went to another hospital's emergency room with complaints of epigastric pain. The computed tomography scan revealed colon and small intestine prolapse into the right thoracic cavity. She was referred to our hospital and underwent surgery the next day. Two adjacent right diaphragm defects were successfully sutured with nonabsorbable sutures. The patient was discharged on postoperative day 11.
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Affiliation(s)
- Yuki Ohya
- From the Department of Surgery, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto, Japan
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13
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Mansour A, Horesh N, Gutman M, Goldes Y. Giant Diaphragmatic Hernia in Elastoderma. Isr Med Assoc J 2022; 24:121-122. [PMID: 35187904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Aiham Mansour
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Bennet S, Wang M, Spiro C, Tog C. Gastric volvulus and tension gastrothorax secondary to spontaneous transdiaphragmatic intercostal hernia. BMJ Case Rep 2022; 15:e246832. [PMID: 35039367 PMCID: PMC8768873 DOI: 10.1136/bcr-2021-246832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/04/2022] Open
Abstract
Spontaneous transdiaphragmatic intercostal hernia is an extremely rare clinical entity featuring dual defects in the diaphragm and chest wall. We report on the case of a 59-year-old man who developed a large left-sided hernia secondary to the minor trauma of a coughing fit. The hernia subsequently enlarged over the course of 3 years until it contained the stomach, leading to a gastric volvulus and tension gastrothorax with secondary pneumothorax. A subtotal gastrectomy was performed with Roux-en-Y reconstruction, and he made a full recovery.
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Affiliation(s)
- Simon Bennet
- Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Wang
- Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Calista Spiro
- Upper Gastrointestinal Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
| | - Chek Tog
- Upper Gastrointestinal Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
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Alnagar A, Barghash M, Kassem A, Hanora M. Diaphragmatic hernia after radiofrequency ablation of liver tumor case report and literature review. Rozhl Chir 2022; 101:508-513. [PMID: 36402564 DOI: 10.33699/pis.2022.101.10.508-513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Radiofrequency ablation is an effective management modality for irresectable primary and secondary liver tumors. Some serious complications have been reported including diaphragmatic hernia. Diaphragmatic hernia is the protrusion of abdominal viscera into the thoracic cavity through a diaphragmatic defect and usually classified into congenital and acquired. After RFA, diaphragmatic hernia is a rarely-reported complication. CASE REPORT A 62-year-old male patient, known to have liver cirrhosis on top of hepatitis C virus, presented to the emergency department with generalized abdominal pain and vomiting four months after having a RFA procedure for a liver tumor in segment VIII. Computed tomography showed diaphragmatic hernia with strangulated terminal ileum in the chest. Emergency laparotomy was performed with resection of an ileal segment and creation of double barrel ileostomy. The patient was discharged in a good condition after tolerating oral intake. CONCLUSION Radiofrequency ablation is an effective modality for management of the primary and secondary liver tumors. Despite its safety, some complication may happen owing to its thermal effect and the associated patients general condition. Many techniques have been described to decrease its thermal injury. Diaphragmatic hernia is a rare complication after RFA. Its clinical presentation may be confusing and it may occur as early as one month after RFA. Its diagnosis depends mainly on computed tomography. Emergency surgical management is the standard approach.
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Vassiliu P, Parasyris S, Sidiropoulos TA, Margaris I, Oikonomopoulos N, Kostopanagiotou K, Smyrniotis V, Arkadopoulos N. Intrapericardial Hernia after Transdiaphragmatic Approach of Intrathoracic IVC. Ann Vasc Surg 2021; 77:349.e1-349.e4. [PMID: 34450288 DOI: 10.1016/j.avsg.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022]
Abstract
Trauma and abdominal surgery that involves the diaphragm and pericardium rarely ends up in post-operative visceral herniation into the pericardial cavity. Urgent intervention is crucial to restore the cardiac output and prevent bowel strangulation. A case of a patient with intrapericardial hernia following nephrectomy for renal cell carcinoma and en block resection of an IVC neoplasmatic thrombus via transdiaphragmatic approach is presented.
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MESH Headings
- Aged
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/surgery
- Female
- Hernia, Abdominal/diagnostic imaging
- Hernia, Abdominal/etiology
- Hernia, Abdominal/surgery
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/etiology
- Hernia, Diaphragmatic/surgery
- Herniorrhaphy
- Humans
- Jejunum/diagnostic imaging
- Jejunum/surgery
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Nephrectomy/adverse effects
- Pericardium/diagnostic imaging
- Pericardium/surgery
- Treatment Outcome
- Vascular Surgical Procedures/adverse effects
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/surgery
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Affiliation(s)
- Panteleimon Vassiliu
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Stavros Parasyris
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece.
| | - Theodoros A Sidiropoulos
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis Margaris
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Oikonomopoulos
- 2nd Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Kostas Kostopanagiotou
- Department of Thoracic Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Vasileios Smyrniotis
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Greece
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17
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Alvarez Padilla FN, Brosutti OD. Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia. Medicina (B Aires) 2021; 81:467-469. [PMID: 34137711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Diaphragmatic hernia during pregnancy or puerperium are rare entities that, in the event of a complication, represent a life-threatening emergency for both mother and the unborn child. Resolution in many cases requires a combined access through the thoracic and abdominal cavity to manage the complications of necrosis and/or perforation of an abdominal viscera. To treat the thoracic cavity, thoracotomy is the most described approach. Even more, the minimally invasive access by video-assisted thoracic surgery (VATS) is not widely referenced in the literature despite its clear benefits of this technique in the recovery of patients, even in emergencies. We present the case of a postpartum right diaphragmatic hernia, complicated by necrosis of the colonic wall, treated by combined VATS approach and laparotomy in the emergency.
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Affiliation(s)
| | - Oscar D Brosutti
- Servicio de Cirugía General, Sanatorio Santa Fe, Santa Fe, Argentina
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18
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Kawada J, Hata T, Murotani M, Nagano S, Shigetsu K, Imamura H, Yoneda N, Kidogami S, Mokutani Y, Kishimoto T, Hashimoto Y, Hirose H, Yoshioka S, Tamura S, Sasaki Y. [Laparoscopic Repair of Incarcerated Diaphragmatic Hernia as a Complication of Left Hepatectomy for Liver Cancer]. Gan To Kagaku Ryoho 2020; 47:1630-1632. [PMID: 33268743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report a case of laparoscopic repair of a diaphragmatic hernia after left hepatectomy for liver cancer. A woman in her 70s had undergone left hepatectomy for liver cancer 9 months earlier, and she was admitted because of epigastric pain after vomiting immediately following contrast-enhanced CT. On the next day, contrast-enhanced CT revealed an incarcerated diaphragmatic hernia, for which laparoscopic diaphragmatic hernia repair was performed. The incarcerated stomach was pushed back into the abdominal cavity, and the diaphragm was closed with 2-0 proline sutures. Gastric resection was not performed because the blood flow gradually improved. The postoperative course was good; the patient was discharged on the 7th postoperative day and is under outpatient follow-up.
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Abstract
CASE DESCRIPTION A 1-year-old spayed female domestic shorthair cat was evaluated for a sternal defect and ventral abdominal wall hernia. CLINICAL FINDINGS The cat appeared healthy. Palpation revealed a sternal defect, and the heart could be observed beating underneath the skin at the caudoventral aspect of the thorax. A 3-cm-diameter freely movable mass, consistent with a hernia, was also palpated at the cranioventral aspect of the abdomen. Thoracic radiographic and CT images revealed a sternal cleft, cranial midline abdominal wall hernia, and peritoneopericardial diaphragmatic hernia (PPDH). TREATMENT AND OUTCOME Thoracotomy and celiotomy were performed. The sternal cleft was repaired with a porcine small intestinal submucosa graft, titanium contourable mesh plate, and interrupted 25-gauge cerclage wires. A diaphragmatic herniorrhaphy was used to correct the PPDH. Thoracic radiographs were obtained immediately after surgery to confirm repair of the sternal cleft, abdominal wall hernia, and PPDH and at 1 and 3 months after surgery to assess the surgical implants, which had not migrated and were intact with only mild bending at the cranial and caudal margins of the mesh plate. At both recheck examinations, the cat appeared healthy with no complications reported by the owner. CLINICAL RELEVANCE A novel surgical technique was used to successfully repair a large sternal cleft in an adult cat with no postoperative complications reported. This technique may be useful for the treatment of sternal clefts in other cats. This was the first report to describe an adult cat with congenital defects consistent with incomplete pentalogy of Cantrell.
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20
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Herráez Cervera B, Moreno Flores A, Llorens Salvador R. Intrapericardial diaphragmatic hernia following cardiac surgery - A case report. Cir Pediatr 2020; 33:91-94. [PMID: 32250073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Intrapericardial diaphragmatic hernia is an abdominal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group. CLINICAL CASE This is the case of a 4-month-old infant undergoing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiological control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intrapericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications. DISCUSSION Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imaging findings are key to perform early diagnosis and surgical treatment.
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Affiliation(s)
- B Herráez Cervera
- Servicio de Radiología Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| | - A Moreno Flores
- Servicio de Radiología Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
| | - R Llorens Salvador
- Servicio de Radiología Pediátrica. Hospital Universitario y Politécnico La Fe. Valencia
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21
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Díaz Candelas DA, de la Plaza Llamas R, Arteaga Peralta V, Ramia JM. Complicated diaphragmatic hernia. Cir Esp 2020; 98:238. [PMID: 31164215 DOI: 10.1016/j.ciresp.2019.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel A Díaz Candelas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Roberto de la Plaza Llamas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Vladimir Arteaga Peralta
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Jose M Ramia
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
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22
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Yankov G, Mekov E, Kovacheva M, Vladimirov B, Petkov R. Diaphragmatic Hernia after Transthoracic Esophagectomy. Am Surg 2020; 86:e136-e138. [PMID: 32223821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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23
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M Hennessy M, Ivanovski I, Spartalis E, Chrysikos D, Athanasiou A. Diaphragmatic hernia following esophagectomy for esophageal cancer: A systematic review. J BUON 2019; 24:1793-1800. [PMID: 31786839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Diaphragmatic hernia following an esophagectomy for esophageal cancer (EC) can be both an early and late complication. The esophageal hiatus within the diaphragm is disrupted during the operation. However, the incidence of Post-Esophagectomy Diaphragmatic Hernia (PEDH) is unknown. PEDH can be life-threatening and surgical treatment is challenging. However, all PEDH do not require surgery. The rate of EC diagnosis is rising. Therefore, esophageal surgery, particularly esophagectomy, is gradually increasing. Undoubtedly, the numbers of PEDH increase as well. METHODS This review describes the presentation and diagnosis of PEDH after surgery for esophageal malignancy, as well as the management options for PEDH. RESULTS Fifteen papers regarding PEDH have been published. There are many different surgical approaches to complete an esophagectomy, while there are different approaches to repair PEDH. CONCLUSION Upper GI surgeons need to have an index of suspicion for PEDH. They must investigate and operate these patients if this complication develops, since an immediate surgery has a high mortality and poor outcome.
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24
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Casimiro Pérez JA, Fernández Quesada C, Jiménez Díaz L, Acosta Mérida MA. Giant incarcerated diaphragmatic hernia post-esophagectomy (McKeown) with severe dilatation of gastric esophagoplasty. Cir Esp 2019; 98:99. [PMID: 30961886 DOI: 10.1016/j.ciresp.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 02/28/2019] [Indexed: 11/17/2022]
Affiliation(s)
- José Antonio Casimiro Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Carlos Fernández Quesada
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Laura Jiménez Díaz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - María Asunción Acosta Mérida
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Abstract
RATIONALE The case of parasternal diaphragmatic hernia is relatively rare in adults. The best way for the treatment of diaphragmatic hernia is to receive operation, yet which surgical method is the best remains unclear. PATIENT CONCERNS An elderly woman in the hospital was complaining about upper abdominal pain that was complicated by the parasternal diaphragmatic hernia. Such state was found accidentally in a car accident and diagnosed by a computed tomography (CT) scan. DIAGNOSIS Parasternal diaphragmatic hernia. INTERVENTIONS Laparoscopic surgery was performed. The hernial component was easily drawn back into the abdominal cavity, and hernia sac was resected. Closure hernia sac underwent full-thickness U-shaped transabdominal wall sutures with 3-0 Prolene (ETHICON) after straightening the needle without a mesh. OUTCOMES The patient recovered quickly without postoperative complication. The hospital stay was 2 days. There was no recurrence and symptoms at a 6-month follow-up. LESSONS Laparoscopic extracorporeal repair without using a mesh is a safe, quick, and effective approach. It seems to be an effective treatment of the parasternal diaphragmatic hernia, in particular for elderly patients.
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Abstract
Asymptomatic right diaphragmatic rupture with liver and gallbladder herniation and secondary Budd-Chiari syndrome is a rare complication of abdominal trauma. In this setting, the management of gallbladder stones remains poorly described and may require a thoracic approach.
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Affiliation(s)
- M Paci
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France; Department of General Surgery, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - F Cauchy
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France.
| | - O Farges
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, Université Paris VII Diderot, Assistance Publique-Hôpitaux de Paris, 100, boulevard du Général Leclerc, 92110 Clichy, Paris, France
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27
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Sommese K, Kelley K, Tan B, Fontana M, Brooks J. Iatrogenic Incarcerated Diaphragmatic Hernia after Nissen Fundoplication. Am Surg 2018; 84:1195-1196. [PMID: 30064587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Postoperative iatrogenic diaphragmatic hernias have been reported sparingly after several thoracic and abdominal surgeries. Although rare, a delay in diagnosis can lead to life-threatening cases of strangulation or perforation, as well as cardiovascular and respiratory insufficiency. This is a case of a 78-year-old female who developed acute obstructive symptoms secondary to herniation of the distal stomach through a defect in the central tendon of the diaphragm. The diaphragmatic defect was presumed to be iatrogenically acquired after Nissen fundoplication one year prior. Other etiologies were not as likely considering that she had never had any trauma to her chest or abdomen and had no history suggestive of a congenital nature for the diaphragmatic hernia. The hernia was successfully decompressed laparoscopically with the stomach having ischemic changes along the greater curvature, necessitating gastric wedge resection. The diaphragmatic defect, which was lengthened to reduce the edematous incarcerated stomach, was repaired primarily. The patient had an uneventful postoperative course. This case highlights the potential complication of incarcerated diaphragmatic hernia after Nissen fundoplication. Late diagnosis of iatrogenic diaphragmatic hernias is frequent because of nonspecific symptoms and surgery is indicated at the time of diagnosis.
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Wang K, Gao W, Ma N, Meng XC, Zhang W, Sun C, Dong C, Wu B. Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation: Three cases report and review of literature. Medicine (Baltimore) 2018; 97:e0346. [PMID: 29642174 PMCID: PMC5908575 DOI: 10.1097/md.0000000000010346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Diaphragmatic hernia (DH) in pediatrics following living donor liver transplantation (LDLT) has been seldom reported in the past. PATIENT CONCERNS We report successful diagnosis and treatment of three pediatric cases with DH secondary to LDLT, discuss the possible etiology, and review the relevant literature. DIAGNOSES The primary disease was biliary atresia and DH was diagnosed by computed tomography scan or x-ray of chest. INTERVENTIONS Laparotomy was performed successfully to repair the DH. OUTCOMES The respiratory and digestive function was gradually recovered in 1 to 2 weeks after repair operation. In 2 to 8 months follow-up, patients were asymptomatic without any respiratory or digestive complications. LESSONS DH post-LDLT should be recognized as a possible complication when a left lateral segment graft is used. Careful clinical examination and prompt surgery could minimize complications.
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29
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Affiliation(s)
- E L Nikonov
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
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30
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Mill V, Brodin C. [Large bowel obstruction with effects on the mediastinum]. Lakartidningen 2017; 114:EFHA. [PMID: 28440847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Large bowel obstruction with effects on the mediastinum We present a patient in which the colon and left kidney herniated through a left-sided diaphragmatic hernia. The cause of the hernia was unknown, although most likely it emanated from an earlier diaphragmatic rupture caused by trauma. Due to a diverticular stenosis of the sigmoid colon, the patient developed large bowel obstruction, causing displacement of mediastinal structures. Emergency laparotomy and anterolateral thoracotomy was performed.
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Affiliation(s)
- Victor Mill
- Kliniken för kirurgi och urologi, Nyköpings Lasarett - Nyköping, Sweden Kirurgkliniken Nyköpings Lasarett - Nyköping, Sweden
| | - Claes Brodin
- Kliniken för kirurgi och urologi, Nyköpings Lasarett - Nyköping, Sweden Kirurgkliniken Nyköpings Lasarett - Nyköping, Sweden
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31
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Eastwood MP, Joyeux L, Pranpanus S, Van der Merwe J, Verbeken E, De Vleeschauwer S, Gayan-Ramirez G, Deprest J. A growing animal model for neonatal repair of large diaphragmatic defects to evaluate patch function and outcome. PLoS One 2017; 12:e0174332. [PMID: 28358826 PMCID: PMC5373533 DOI: 10.1371/journal.pone.0174332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives We aimed to develop a more representative model for neonatal congenital diaphragmatic hernia repair in a large animal model, by creating a large defect in a fast-growing pup, using functional pulmonary and diaphragmatic read outs. Background Grafts are increasingly used to repair congenital diaphragmatic hernia with the risk of local complications. Growing animal models have been used to test novel materials. Methods 6-week-old rabbits underwent fiberoptic intubation, left subcostal laparotomy and hemi-diaphragmatic excision (either nearly complete (n = 13) or 3*3cm (n = 9)) and primary closure (Gore-Tex patch). Survival was further increased by moving to laryngeal mask airway ventilation (n = 15). Sham operated animals were used as controls (n = 6). Survivors (90 days) underwent chest X-Ray (scoliosis), measurements of maximum transdiaphragmatic pressure and breathing pattern (tidal volume, Pdi). Rates of herniation, lung histology and right hemi-diaphragmatic fiber cross-sectional area was measured. Results Rabbits surviving 90 days doubled their weight. Only one (8%) with a complete defect survived to 90 days. In the 3*3cm defect group all survived to 48 hours, however seven (78%) died later (16–49 days) from respiratory failure secondary to tracheal stricture formation. Use of a laryngeal mask airway doubled 90-day survival, one pup displaying herniation (17%). Cobb angel measurements, breathing pattern, and lung histology were comparable to sham. Under exertion, sham animals increased their maximum transdiaphragmatic pressure 134% compared to a 71% increase in patched animals (p<0.05). Patched animals had a compensatory increase in their right hemi-diaphragmatic fiber cross-sectional area (p<0.0001). Conclusions A primarily patched 3*3cm defect in growing rabbits, under laryngeal mask airway ventilation, enables adequate survival with normal lung function and reduced maximum transdiaphragmatic pressure compared to controls.
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Affiliation(s)
- Mary Patrice Eastwood
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Joyeux
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Savitree Pranpanus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Prince of Songkla University, Hat Yai, Thailand
| | - Johannes Van der Merwe
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Pathology, Group Biomedical Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Jan Deprest
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
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32
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Whealon MD, Blondet JJ, Gahagan JV, Phelan MJ, Nguyen NT. Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair. Surg Endosc 2017; 31:4224-4230. [PMID: 28342131 DOI: 10.1007/s00464-017-5482-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 02/16/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is no published data regarding the relationship between hospital volume and outcomes in patients undergoing laparoscopic diaphragmatic hernia repair. We hypothesize that hospitals performing high case volume have improved outcomes compared to low-volume hospitals. MATERIALS AND METHODS We reviewed the National Inpatient Sample (NIS) database between 2008 and 2012 for adults with the diagnosis of diaphragmatic hernia who underwent elective laparoscopic repair of diaphragmatic Hernia and/or Nissen fundoplication. Pediatric, emergent, and open cases were excluded. Main outcome measures included logistic regression analysis of factors predictive of in-hospital mortality and outcomes according to annual hospital case volume. RESULTS A total of 31,228 laparoscopic diaphragmatic hernia operations were analyzed. The overall in-hospital mortality was 0.14%. Risk factors for higher in-hospital mortality included renal failure (AOR: 6.26; 95% CI: 2.48-15.78; p < 0.001), age>60 years (AOR: 5.06; 95% CI: 2.38-10.76; p < 0.001), and CHF (AOR: 3.80; 95% CI: 1.39-10.38; p = 0.009) while an incremental increase in volume of 10 cases/year (AOR: 0.89; 95% CI: 0.81-0.98; p = 0.019) and diabetes (AOR: 0.34; 95% CI: 0.12-0.93; p = 0.036) decreases mortality. There was a small but significant inverse relationship between hospital case volume and mortality with a 10% reduction in adjusted odds of in-hospital mortality for every increase in 10 cases per year. Using 10 cases per year as the volume threshold, low-volume hospitals (≤10 cases/year) had almost a twofold higher mortality compared to high-volume hospitals (0.23 vs. 0.12%, respectively, p = 0.02). CONCLUSIONS There was a small but significant inverse relationship between the hospitals' case volume and mortality in laparoscopic diaphragmatic hernia repair.
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Affiliation(s)
- Matthew D Whealon
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Juan J Blondet
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - John V Gahagan
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Michael J Phelan
- Department of Statistics, University of California, Irvine, Irvine, California, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
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33
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Claes S, Beck P, Armbruster K, Diehl H, Eggstein S. [Back pain and acute dyspnea - an unusual cause]. Chirurg 2017; 88:615-617. [PMID: 28321453 DOI: 10.1007/s00104-017-0407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Claes
- HELIOS Klinik Titisee-Neustadt, Jostalstr. 12, 79822, Titisee-Neustadt, Deutschland
| | - P Beck
- HELIOS Klinik Titisee-Neustadt, Jostalstr. 12, 79822, Titisee-Neustadt, Deutschland.
| | - K Armbruster
- HELIOS Klinik Titisee-Neustadt, Jostalstr. 12, 79822, Titisee-Neustadt, Deutschland
| | - H Diehl
- HELIOS Klinik Titisee-Neustadt, Jostalstr. 12, 79822, Titisee-Neustadt, Deutschland
| | - S Eggstein
- HELIOS Klinik Titisee-Neustadt, Jostalstr. 12, 79822, Titisee-Neustadt, Deutschland
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Abstract
Microwave ablation (MWA) is a new technology developed in recent years, which is widely used in various disciplines. Microwave ablation is an alternative to surgery in the management of various tumors, and it has been demonstrated to be effective in the management of primary tumors and metastatic tumors. Microwave ablation is widely used in the treatment of hepatocellular carcinoma with an obvious effect and less side effects, and only 2.7% had serious complications. Many studies have confirmed the complications are thermal damage, hemorrhage, pleural effusion, bile leak, tumor seeding, hepatic abscess, cholangitis, and so forth. But diaphragm perforation is rare, and it is probably the first case reported. This article describes diaphragmatic perforation secondary to MWA of the liver with subsequent pleural effusion and diaphragmatic hernia. We also describe its management via the laparoscopic approach.
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Affiliation(s)
- Qing-Chen Liang
- Department of Surgery, Beijing Airport Hospital, Beijing, China. E-mail.
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35
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Abstract
Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence with great diagnostic difficulty. The authors present a case of right diaphragmatic rupture related to peritonitis due to perforated duodenal ulcer in previous (1 year before) thoraco-abdominal trauma with complete intra-thoracic herniation of the liver, gallbladder, ascending and transverse colon and lung collapse. The preoperative diagnosis has been based on clinical, chest X-ray, and ultrasound examination. The patient, because of very serious respiratory and hemodynamic distress, immediately underwent surgery (thoraco-laparotomic approach) with reduction of the liver, gallbladder, ascending and transverse colon in the abdominal cavity, perforated duodenal ulcer suture and repair of diaphragmatic tear using an unusual repair mode: suture of autologous fascia lata graft to the diaphragm. Postoperative chest radiography showed the normal location of right diaphragmatic border.
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MESH Headings
- Adult
- Colon, Ascending/surgery
- Colon, Transverse/surgery
- Duodenal Ulcer/complications
- Gallbladder/surgery
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/etiology
- Hernia, Diaphragmatic/microbiology
- Hernia, Diaphragmatic/surgery
- Herniorrhaphy
- Humans
- Liver/surgery
- Male
- Peritonitis/complications
- Peritonitis/microbiology
- Pulmonary Atelectasis/diagnostic imaging
- Pulmonary Atelectasis/etiology
- Pulmonary Atelectasis/surgery
- Rupture, Spontaneous/etiology
- Treatment Outcome
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/etiology
- Wounds, Nonpenetrating/surgery
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36
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Moris D, Dimitrokallis N, Spartalis E, Vailas M, Markakis C, Vernadakis S. Diaphragmatic Hernias after Living Donor Hepatectomy: A Critical Reappraisal. Am Surg 2016; 82:E81-E83. [PMID: 27097612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Demetrios Moris
- First Department of Surgery, National and Kapodistrian University of Athens Medical School, "Laikon" General Hospital, Athens, Greece
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Dumanskiy YV, Stepko VA, Sinyachenko OV. [THE RISK FACTORS OF LETHAL COMPLICATIONS IN EARLY POSTOPERATIVE PERIOD IN PATIENTS, SUFFERING GASTROESOPHAGEAL ZONE MALIGNANCIES]. Klin Khir 2016:5-7. [PMID: 27244907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Abstract The factors, determining possibility of early postoperative morbidity occurrence in patients, suffering gastro-esophageal zone cancer, were analyzed. After radical operation performance (gastrectomy, gastric and esophageal resection) 5.7% patients died. Insufficience of the anastomosis sutures with peritonitis occurrence, an acute hepato-renal insufficience, an acute coronary syndrome, pulmonary thromboembolism, pneumonia, the brain insult, pancreonecrosis and mesenterial thrombosis constituted the main morbidities. The complications occurrence depends upon the tumoral process course severity, morphological variant of cancer, presence of concomitant diaphragmatic hernia and the blood rheological properties. Initially high indices of the blood sera present a rheological properties of blood serum may serve as a prognostic criterion of the postoperative complications occurrence in the patients.
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Suciu BA. A fatal complication of an incarcerated diaphragmatic hernia: pyo-pneumopericardium due to a gastro-pericardial fistula Case report and literature review. Ann Ital Chir 2016; 87:75-78. [PMID: 27026068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia. Usually, it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication. CASE REPORT We present the case of a 65 year old man who was admitted to our emergency service with clinical signs of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatic hernia was diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic and abdominal), discerning during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula due to an incarcerated diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardial fistula, evacuation of the pericardial abscess, performing the splenectomy (in order to have a better surgical access) and adequate treatment of the diaphragmatic hernia. Despite the medical efforts, the patient died on the 10th postoperative day due to septic complications. To our knowledge this is the first case reported in the literature of gastro-pericardial fistula complicated with pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing a double surgical approach (thoracic and abdominal) we can provide a proper resolution of the case, also based on the objective situation found during surgery, where the splenectomy can provide an easier approach to the diaphragmatic hernia. KEY WORDS Diaphragmatic hernia, Gastropericardial fistula, Pyo-pneumopericardium.
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Kaya C, Cebeci H. Anesthetic Challenges and Management in a case of Jarcho-Levin Syndrome with a Neural Tube Defect in a Newborn. Bol Asoc Med P R 2016; 108:17-20. [PMID: 29164846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defects appear to be common findings in patients with JLS, and chest hypoplasia frequently leads to respiratory insufficiency and death in early childhood. There have been no previous studies in the literature on the anesthetic management of JLS with neural tube defects and hydrocephalus. Therefore, we have reported a case of JLS in a female full-term newborn, who underwent surgery for myelomeningocele repair and ventriculoperitoneal shunting, with the associated anesthetic challenges and their management.
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Suciu BA, Opris M, Bud V, Copotoiu C, Brînzaniuc K, Muresan M. A fatal complication of an incarcerated diaphragmatic hernia Pyo-pneumopericardium due to a gastro-pericardial fistula, case report and literature review. Ann Ital Chir 2015; 86:S2239253X15024391. [PMID: 26696281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED A fatal complication of an incarcerated diaphragmatic hernia: pyo-pneumopericardium due to a gastro-pericardial fistula, case report and literature review INTRODUCTION The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia. Usually, it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication. CASE REPORT We present the case of a 65 year old man who was admitted to our emergency service with clinical signs of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatic hernia was diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic and abdominal), discerning during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula due to an incarcerated diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardial fistula, evacuation of the pericardial abscess, performing the splenectomy (in order to have a better surgical access) and adequate treatment of the diaphragmatic hernia. Despite the medical efforts, the patient died on the 10th postoperative day due to septic complications. To our knowledge this is the first case reported in the literature of gastro-pericardial fistula complicated with pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing a double surgical approach (thoracic and abdominal) we can provide a proper resolution of the case, also based on the objective situation found during surgery, where the splenectomy can provide an easier approach to the diaphragmatic hernia.
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41
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Kirnap M, Akdur A, Ozcay F, Soy E, Coskun M, Moray G, Haberal M. Diaphragmatic Hernia After Pediatric Liver Transplant. EXP CLIN TRANSPLANT 2015; 13:471-474. [PMID: 26450470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diaphragmatic hernia is an unusual complication after pediatric liver transplant. Nearly half of bowel obstruction cases, which require surgical intervention in liver transplant patients, are caused by diaphragmatic hernia. The smaller patients are at risk for higher rates of diaphragmatic complication after pediatric liver transplant, but diaphragmatic hernia has not been reported as a unique occurrence. Here, we report 3 cases of diaphragmatic hernia after liver transplant and discuss the possible contributing factors. Diaphragmatic hernia should nevertheless be added to the list of potential complications after liver transplant in the pediatric population. Pediatric transplant physicians and surgeons should be aware of this complication so that it is recognized promptly in both acute and nonacute settings and appropriate action is taken.
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Affiliation(s)
- Mahir Kirnap
- Department of General Surgery and Transplantation, Baskent University Faculty of Medicine, Ankara, Turkey
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Abstract
Diaphragmatic hernias (DH) occurring after pediatric liver transplantation (LT) are rare. However, such complications have been previously reported in the literature and treatment has always been surgical repair via laparotomy. We report our experience of minimally invasive thoracoscopic approach for repair of DH occurring after LT in pediatric recipients.From April 2010 to December 2014, 7 cases of DH were identified in pediatric LT recipient in Samsung Medical Center. Thoracoscopic repair was attempted in 3 patients. Patients' medical records were retrospectively reviewed.Case 1 was a 12-month-old boy, having received deceased donor LT for biliary atresia (BA) 5 months ago. He presented with dyspnea and left-sided DH was detected. Thoracoscopic repair was successfully done and the boy was discharged at postoperative day 7. Case 2 was a 13-month-old boy, having received deceased donor LT for BA 2 months ago. He presented with vomiting and right-sided DH was detected. Thoracoscopic repair was done along with primary repair of herniated small bowel that was perforated while attempting reduction into the peritoneal cavity. The boy recovered from the surgery without complications and was discharged on the 10th postoperative day. Case 3 was a 43-month-old girl, having received deceased donor LT for Alagille syndrome 28 months ago. She was diagnosed with right-sided DH during steroid pulse therapy for acute rejection. Thoracoscopic repair was attempted but a segment of necrotic bowel was noticed along with bile colored pleural effusion and severe adhesion in the thoracic cavity. She received DH repair with small bowel resection and anastomosis via laparotomy.Thoracoscopic repair was attempted in 3 cases of DH occurring after LT in pediatric recipients. With experience and expertise in pediatric minimally invasive surgery, thoracoscopic approach is feasible in this rare population of patients.
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Affiliation(s)
- Sanghoon Lee
- From Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
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Schiergens TS, Koch JG, Khalil PN, Graser A, Zügel NP, Jauch KW, Kleespies A. Right-sided diaphragmatic rupture after repair of a large Morgagni hernia. Hernia 2015; 19:671-675. [PMID: 26405726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a case of a combination of primary and secondary diaphragmatic hernia in a 63-year male patient. For progressive dyspnea and palpitations caused by a large and symptomatic Morgagni hernia resulting in a right-sided enterothorax, an open tension-free mesh repair was performed. The postoperative course was complicated by a secondary hepatothorax through a spontaneous rupture of the right diaphragm. Primary mesh repair of the Morgagni hernia, however, proved to be sufficient. This recurrent herniation might be a consequence of (1) preexisting atrophy of the right diaphragm caused by disposition and/or long-term diaphragmatic dysfunction due to the large hernia, combined with (2) further thinning out of the diaphragm by intraoperative hernia sac resection, and (3) postoperative increase of intra-abdominal pressure.
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44
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Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J. Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model. PLoS One 2015; 10:e0132021. [PMID: 26147985 PMCID: PMC4493058 DOI: 10.1371/journal.pone.0132021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes. Materials and Methods 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue. Results Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05). Conclusions Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.
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Affiliation(s)
- Steffi Mayer
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Michele Ruol
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Padua, Padua, Italy
| | - Stefano Manodoro
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Monza, Monza, Italy
| | - Manuel Kramer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Holger Till
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan Deprest
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
- * E-mail:
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Chamary SL, Chamary VL. Laparoscopic features and repair of a combined left Spigelian hernia and left Morgagni diaphragmatic hernia. Ann R Coll Surg Engl 2015; 97:e25-6. [PMID: 25723678 PMCID: PMC4473424 DOI: 10.1308/003588414x14055925060596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2014] [Indexed: 11/22/2022] Open
Abstract
Both Spigelian and Morgagni hernias cause serious morbidity so early diagnosis and timely treatment are necessary. These two types of hernia are more commonly found on the right side of patients. They are rare individually in adults and even rarer in combination. So far, an association between the two hernias has only been reported on the right. We describe the first case of a Spigelian hernia and a Morgagni hernia in a 62-year-old woman, both occurring on the left side. Our accompanying video describes several laparoscopic features that will help lead to early detection and diagnosis.
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Affiliation(s)
| | - VL Chamary
- Aneurin Bevan University Health Board, UK
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47
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Mutanen A, Sandelin H, Nieminen A, Huusari H, Toikkanen V. [Diaphragmatic rupture: case report of a rare complication of labor]. Duodecim 2015; 131:753-756. [PMID: 26237891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A diaphragmatic rupture associated with labor is a rare complication of pregnancy with high fetal and maternal mortality. Due to non-specific symptoms and rareness of the disease the diagnosis can be challenging. We present a case of a healthy 26-year old woman with one previous childbirth who presented upper abdominal pain, tachycardia and dyspnea during labor. Immediately after labor, a left-sided diaphragmatic rupture complicated with ventricle perforation was diagnosed. After prompt diagnosis and immediate surgical care, including thoracotomy and laparotomy, both patient and child experienced a full recovery.
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48
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Bukvić N, Versić AB, Bacić G, Gusić N, Nikolić H, Bukvić F. Incarcerated diaphragmatic hernia--differential diagnoses. Coll Antropol 2014; 38:1203-1205. [PMID: 25842758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The incarceration of diaphragmatic hernia is very rare. We present a case of a four-year-old girl who developed the incarceration of left-sided diaphragmatic hernia, who, until then, was completely asymptomatic. This incarceration of the hernia represented a surgical emergency presenting as obstructive ileus and a severe respiratory distress which developed from what appeared to be full health. During a brief pre-operative examination a number of differential diagnoses were suggested. Along with the laboratory blood analysis (complete blood count and acid-base balance) a plain thoracic and abdominal radiography was done (babygram). After that, through an inserted nasal-gastric tube, barium meal of the upper gastrointestinal tract was done, showing abdominal organs in the left half of the thorax and a significant shift of the mediastinum to the right. With an urgent upper medial laparotomy we accessed the abdominal cavity and made the correct diagnosis. An opening was shown in the rear part of the left hemi-diaphragm with thickened and edematous edges, approx. 6 cm in diameter with incarcerated content. The incarcerated abdominal organs (stomach, transversal colon, small intestine and spleen) gradually moved into the abdominal cavity. The opening was closed with nonresorptive sutures (TiCron) size 2-0 with aprevious control and ventilated expansion of the well-developed left lung. In postoperative course the acid-base balance quickly recovered, as well as the general state of the patient and radiography showed a good expansion and lucency of the lung parenchyma and a return of the mediastinum into the middle part of the thorax.
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49
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Abstract
Bochdalek hernias usually present in neonates with respiratory failure, need to be operated early and are associated with a high mortality. We describe an adult patient who came to the emergency department with nonspecific recurrent chest and abdominal pain. A computed tomography scan showed a large posterolateral diaphragmatic defect and an oversized spleen. The hernia was repaired by a thoracoabdominal approach and Gore-Tex patch. Congenital diaphragmatic hernias are rare and are associated with nonspecific symptoms in adults. With suspicious chest or abdominal radiographs, a computed tomography scan is essential to plan an individualized surgical intervention.
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Affiliation(s)
- Anique Herling
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Fahd Makhdom
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Abdullah Al-Shehri
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - David S Mulder
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada.
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50
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Betzold RD, Kalkwarf KJ, Jiang D, Nesmith RB, Khandelwal C. Strangulated pericardial hernia after a remote subxiphoid pericardial window for trauma. Am Surg 2014; 80:e261-e262. [PMID: 25197855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Richard D Betzold
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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