Hernia diafragmática congénita: caso clínico y la importancia del diagnóstico prenatal / Congenital diaphragmatic hernia: a case report

Congenital diaphragmatic hernia (CDH) is a disease with a high postnatal morbidity and mortality due to the lung hypoplasia associated, which is why it is so important an early diagnosis, being recommended in average in the second trimester of gestation. This finding allows a proper immediate management of the newborn in a specialized health center. Through a case report we will present a review of CDH types and diagnosis, making emphasis in theultrasonographic diagnosis during pregnancy.

La Hernia Diafragmática Congénita (HDC) es una enfermedad que presenta una alta morbimortalidad postnatal por la hipoplasia pulmonar asociada, poresto es importante un diagnóstico precoz, siendo recomendado en promedio dentro del segundo trimestre de gestación. Este hallazgo permite unadecuado manejo inmediato del recién nacido en un centro de salud especializado. En base al caso clínico que se presentará a continuación realizamos una revisión sobre los tiposy el diagnóstico de la HDC haciendo énfasis en el diagnóstico ultrasonográfico durante el embarazo.

Congenital hernias of the diaphragm in children

Congenital diaphragmatic hernia [CDH] is a major congenital malformation. Different types have been described. Bochdalek hernia [BH] remains most prevalent with high mortality rates. Other variants are less common and carry good prognosis. Although, the diagnosis can be made antenatally, the presentation may be delayed. There is paucity of national literature on CDHs. We present our experience with these challenging paediatric malformations. Medical records of 18 patients [<14 years] treated by the group of authors between October 1998 and April 2002 were retrospectively reviewed and demographic data, clinical presentation, morbidity and outcome were studied. There were 13 [72%] children with Bochdalek hernia, 2 [11%] with eventration of the diaphragm, 2 [11%] with hiatus hernia and 1[6%] with a Morgagni hernia. The lesions were more common in girls and all the defects were left sided. The average age at the time of presentation of BH was 23 hours [2 to 72 hours] commonly presenting with cyanosis and respiratory distress. Associated anomalies were documented in 10 [77%] cases; six had multiple malformations and four died before surgery. In other types of CDHs, the mean age at presentation was 39 [18-60] months and they mostly presented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms. Diagnosis was made on history, physical examination, plain x-ray chest, and gastrointestinal contrast study, when required. 14 [78%] children were operated and a sac was present in 5. Post-operative complications occurred in 5 [55%] patients with Bochdalek hernia, which were managed conservatively. The overall survival rate was 67% [n=12]. The different types of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgery was safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalek hernia

Hernia giafragmatica traumatica de aparicion precos / Early traumatic diapharmatic hernia

Las hernias diafmgmáticas de origen traumático son una patología poco frecuente en los mños y generalmente esta asociada a lesiones en otros órganos. Se presenta este caso por la forma de evolución y al presentar solo lesión diafragmática, fue importante el seguimiento de la paciente para un diagnóstico temprano, la conducta fue quirúrgica con laparatomia y sutura del dliafragma roto

Recurrent diaphragmatic hernia: not such a rarity

Survivors of congenital diaphragmatic hernia usually do well, but a large number of them have significant morbidity on follow-up. Recurrent diaphragmatic hernia is one of the long term complications that is not fully addressed because of lack of reporting. Over a period of 8 years from 1989 to 1997, we treated 41 children with different types of congenital diaphragmatic hernia. Five of these patients were subsequently seen with recurrent hernia. The charts of these patients were retrospectively reviewed to identify the causes of recurrence, mode of presentation and methods of treatment. Out of the 41 children with different types of congenital diaphragmatic hernia that we treated, 25 of them survived. There were 5 recurrences [3 males and 2 females], among these 25 cases, an incidence of 25%. The interval from initial repair to the presentation with recurrence was variable from 7 days in one to 15 months [mean 7.7 months]. All were symptomatic except one who presented with right sided pneumonia and on chest x-ray was found to have a recurrent hernia on the other side. One of our patients presented with acute respiratory distress and was found to have a recurrent left sided diaphragmatic hernia with stomach herniation and intrathoracic gastric volvolus. In all patients the hernial defect was large except in one patient with Morgagni's hernia. In all patients silk was used to close the defect except in one where Vinyl was used. In 2 patients with congenital anterolateral diaphragmatic defects, there were hernial sacs that were not excised in one and only excised partially in the other. Recurrent diaphragmatic hernia is not a rarity. Post to diaphragmatic hernia repair, these patients should be followed up and since some of these recurrences are asymptomatic they should have biannual chest x-rays. Only non absorbable sutures should be used in the repair of the defects and where there is a hernial sac it should be excised totally prior to the repair. To obviate the danger of incarceration and strangulation, recurrent diaphragmatic hernias should be repaired