Extraabdominal malposition of the gallbladder.

Anomalies of the biliary system are rare. Anomalies of the gallbladder and anomalies of the bile ducts are distinguished. We observed a newborn with a gallbladder in an extraabdominal malposition, an anomaly that has not been previously described. Ultrasonography revealed a cystic structure with a ductlike connection with the interior surface of the liver and connecting blood vessels. On the bottom side of the liver, there was no orthotopic gallbladder. As the nature of this lesion could not be definitely clarified, an explorative laparotomy was performed. Histologic examination established the diagnosis of an ectopic gallbladder. Malformations of the extrahepatic bile passages are difficult to assess, as only a small percentage of such anomalies produce symptoms. Knowledge of the wide range of possible abnormalities in position, shape, and number of the gallbladder can help in cases where the diagnosis is unclear. Abnormally positioned gallbladders should be removed. The possibility of an ectopic gallbladder must be kept in mind when a suspicious cystic area is encountered in an atypical location, when the gallbladder is not seen in its normal location, or the preoperative diagnostic workup does not confirm the typical clinical symptoms of gallbladder disease.

Congenital diaphragmatic hernia, etiology and management, a 10-year analysis of a single center.

OBJECTIVE: To analyze congenital diaphragmatic hernia (CDH) during a 10-year period at the University of Kiel, from 1995 through 2004, in order to develop a strategy to improve prenatal diagnosis, to be able to consider endoscopical treatment for selected cases and to assess the current postnatal treatment strategies. METHODS: Data were obtained from the fetal medicine ultrasound department, from the birth registry, from the postmortem registry, from the neonatal intensive care unit, from pediatric surgery and from the genetic database. Data were subselected for chromosomes, genetic syndromes, for isolated CDH and for associated anomalies, the lung to head ratio and lung volumes were assessed. Data were analyzed respectively for gestation at diagnosis, the type of CDH, the perinatal management and the postnatal outcome. RESULTS: There were 29 cases of CDH, in 10/29 (34%) the parents requested termination of pregnancy of which two had already died during pregnancy, 12/19 (63%) survived, which was defined as discharge from the neonatal intensive care unit, seven newborns 7/19 (37%) died in the hospital, 5 of these 5/7 (71%) were delivered in Kiel. A prenatal diagnosis was performed in 16/29 (55%), 1/16 (6%), 7/16 (43%) and 8/16 (50%) in the 1st, 2nd and 3rd trimester, respectively; in 10/29 (34%) diagnosis was performed postpartum, in 3/29 (10%) the diagnosis was performed at autopsy following termination of pregnancy. When the liver was in the abdomen, 9/10 (90%) of the children survived, compared to only 3/8 (43%) when the liver was located in the thorax. A lung to head ratio of 0.81 at 24 weeks resulted in death due to pulmonary hypoplasia. CONCLUSIONS: The overall survival in CDH is around 50%, antenatal endoscopical therapy may only be considered, if the diagnosis is performed in the early second trimester, and selection criteria such as the lung to head ratio, associated defects and the chromosomal status can be applied.