Prenatal Diagnosis and Management of a Rare Central Tendon Defect Type of Congenital Diaphragmatic Hernia with a Massive Pericardial Effusion.

The central tendon defect type of congenital diaphragmatic hernia (CDH) is extremely rare and usually associated with a significant pericardial effusion. Prenatal diagnostic ultrasound features of this quite rare entity remain often overlooked or misdiagnosed. There is a dearth of literature about the role of prenatal intervention, often through an elective pericardiocentesis, for the prevention of lung hypoplasia and to decrease the overall neonatal morbidity and mortality. To the best of our knowledge, till date, there is only one case that was subjected to a prenatal intervention. Here, we present a second case of a central tendon defect type of CDH with a large pericardial effusion that was subjected to a prenatal transthoracic pericardiocentesis. Although smooth intubation and ventilation were performed immediately after birth, the infant suffered for several months from respiratory instability. Laparoscopic central tendon hernia repair was performed, and neonate was discharged home at seven months of age. Although prenatal pericardiocentesis may facilitate smoother postnatal intubation and ventilation, its broader effect on respiratory function is uncertain and still remains elusive.

Fetus-in-fetu. Imaging and pathology.

Fetus-in-fetu (FIF), also known as endoparasitic twin, is a form of asymmetric fetal duplication in which the abnormal developing embryo parasitizes the normal co-twin by attaching internally. Here, we report a case of FIF presented as an intra-abdominal cystic mass, which was first detected during an antenatal ultrasound examination of a 32-year-old Saudi mother. At 34 weeks and 4 days of gestation, she had spontaneous labor and delivered a baby boy. The x-ray and CT examination of the baby boy clearly suggested the presence of limbs, vertebral column, and anomalous blood supply to the mass. After laparotomy and surgical removal, the intra-abdominal mass was subjected to detailed pathological examination. Microscopic studies further showed the presence of brain tissue, gut-like structures, fingers, and limbs. The mass was finally confirmed as FIF.

The timing of enterostomy reversal after necrotizing enterocolitis.

BACKGROUND/PURPOSE: Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. The study purpose is to determine if the timing of stoma closure impacts the postoperative course. METHODS: After obtaining institutional review board approval, records of patients with NEC who received a stoma between 2003 and 2007 at 2 pediatric institutions were reviewed. Data collected included time interval between stoma creation and closure, indication for closure, postoperative complications, time to feeds, and length of neonatal intensive care unit and hospital stays. For analysis purposes, patients were divided in 2 groups: 1, stoma closed within 10 weeks; and 2, stoma closed more than 10 weeks after construction. RESULTS: There were 37 patients: 13 in group 1 and 24 in group 2. Group 1 babies were ventilated longer postoperation (7.69 vs 1.08 days, P = .0006). They required total parenteral nutrition for more days (51.62 vs 16.30 days, P = .0486). Group 1 patients took longer to reach full po (19.08 vs 7.86 days, P = .027), and they had a longer length of stay postreversal (113.08 vs 31.32 days, P = .0373). No differences were observed in survival rates or anastomotic complications. CONCLUSION: The timing of stoma reversal significantly impacts the postoperative course after NEC. Unless seriously indicated, stoma closure should be deferred until at least 10 weeks postcreation.