Neonatal congenital diaphragmatic hernia: an optional management strategy in Kuwait

Evaluation of the survival rate in neonate with congenital diaphragmatic hernia [CDH] treated with gentle ventilation, very delayed surgical repair and selective use of surfactant therapy in absence of extra corporeal life support devices. A prospective study of twenty three neonates admitted to lbn Sina Hospital for surgical correction of congenital diaphragmatic hernia between July 1996 to October 1998. These babies were stabilized before transfer pre-operatively at their respective neonatal units under guidelines using gentle ventilation permitting hypercapnia, surfactant therapy and a very delayed surgical correction. Fourteen male and nine female newborns with CDH presented in the first few hours of life, their mean birth weight is 2.850kg [range 2.050-4.300kg]. Twenty patients survived a period of pre-operative medical stabilization ranged between 3-10 days [mean +/- 4.08 days]. Post operative duration of mechanical ventilation ranged between 1-27 days [mean +/- 6.5 days]. Seventeen patients survived i.e. survival rate of 74%. These data demonstrate a significant good survival rate of early presenting CDH neonates with gentle ventilation and very delayed surgical repair

Gastrointestinal duplications: Management pitfalls

We report a case requiring operative treatment because it involved, on different occasions, a duplication cyst of the duodenum, unilateral pulmonary sequestration and gastric duplication as separate surgical problems. This case concerns a seven-month-old female infant who presented with intestinal obstruction and abdominal mass. During an exploratory laparotomy, a duodenal duplication cyst was discovered and excised. An associated gastric duplication cyst was missed because of failure to palpate the stomach during the laparotomy. In this instance, the stomach appeared normal on inspection, a key point for discussion and analysis in this paper. Investigation of postoperative fever following the first operation led to the detection of a pulmonary sequestration on the right side, which was excised later The gastric duplication, as yet undetected, only manifested itself in the second postoperative period as upper and lower gastrointestinal bleeding. The duplication cyst perforated into the stomach, and the stomach perforated into the peritoneal cavity, leading to an abscess cavity. These findings were not revealed by an ultrasound but were finally demonstrated by an upper gastrointestinal contrast study. The child underwent another laparotomy for excision of the gastric duplication. She is now well and thriving. This case report discusses the main lessons learned, together with a relevant literature review