CONGENITAL HERNIAS OF THE DIAPHRAGM IN CHILDREN
Abstract
Background: Congenital diaphragmatic hernia (CDH) is a major congenital malformation.Different types have been described. Bochdalek hernia (BH) remains most prevalent with highmortality rates. Other variants are less common and carry good prognosis. Although, the diagnosiscan be made antenatally, the presentation may be delayed. There is paucity of national literatureon CDHs. We present our experience with these challenging paediatric malformations.Methods: Medical records of 18 patients (£14 years) treated by the group of authors betweenOctober 1998 and April 2002 were retrospectively reviewed and demographic data, clinicalpresentation, morbidity and outcome were studied. Results: There were 13 (72%) children withBochdalek hernia, 2 (11%) with eventration of the diaphragm, 2 (11%) with hiatus hernia and1(6%) with a Morgagni hernia. The lesions were more common in girls and all the defects wereleft 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 weredocumented in 10 (77%) cases; six had multiple malformations and four died before surgery. Inother types of CDHs, the mean age at presentation was 39 (18-60) months and they mostlypresented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms.Diagnosis was made on history, physical examination, plain x -ray chest, and gastrointestinalcontrast 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 weremanaged conservatively. The overall survival rate was 67% (n=12). Conclusion: The differenttypes of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgerywas safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalekhernia.Keywords: Congenital diaphragmatic defects; Bochdalek hernia; Congenital diaphragmaticeventration; Morgagni hernia; Hiatus herniaReferences
Doyle NM, Lally KP. The CDH Study Group and advances in
the clinical care of the patient with congenital diaphragmatic
hernia. Semin Perinatol 2004;28(3):174-84.
Graham G, Devine PC. Antenatal diagnosis of congenital
diaphragmatic hernia. Semin Perinatol 2005; 29(2):69-76.
Robnett-Filly B, Goldstein RB, Sampior D, Hom M. Morgagni
hernia: a rare form of congenital diaphragmatic hernia. J
Ultrasound Med 2003; 22:537-9.
Chacko J, Ford WD, Furness ME. Antenatal detection of hiatus
hernia. Pediatr Surg Int 1998; 13(2-3):163-4.
Elhalaby EA, Abo Sikeena MH. Delayed presentation of
congenital diaphragmatic hernia. Pediatr Surg Int 2002; 18(5-
:480-5.
Clark RH, Hardin WD Jr., Hirschl RB, Jaksic T, Lally KP,
Langham MR Jr, et al. Current surgical management of
congenital diaphragmatic hernia: a report from the Congenital
Diaphragmatic Hernia Study Group.
J Pediatr Surg 1998;33(7):1004-9.
Smith CD, Sade RM, Crawford FA, Othersen HB,
Diaphragmatic paralysis and eventration in infants. J Thorac
Cardiovasc Surg 1986; 91(4):490-7.
Jawad AJ, al-Sammarai AY, al-Rabeeah A. Eventration of the
diaphragm in children. J R Coll Surg Edinb 1991;36:222-24.
Greenholz SK. Congenital diaphragmatic hernia: an overview.
Semin Pediatr Surg 1996; 5:216-23.
Vanamo K. A 45-year perspective of congenital diaphragmatic
hernia. Br J Surg 1996; 83:1758-62.
Puri P, Gorman WA. Natural history of congenital
diaphragmatic hernia: implications for management. Pediatr
Surg Int 1987; 2:327-30.
Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital
diaphragmatic hernia-a tale of two cities: the Boston
experience. J Pediatr Surg 1997; 32:401-5.
Pokorny WJ, McGill CW, Harberg FJ. Morgagni hernias during
infancy: presentation and associated anomalies. J Pediatr Surg
; 19:394-7.
Al-Salem AH, Nawaz A, Matta H, Jacobsz A . Herniation
through the foramen of Morgagni: early diagnosis and
treatment. Pediatr Surg Int 2002; 18:93-7.
Swain JM, Klaus A, Achem SR, Hinder RA. Congenital
diaphragmatic hernia in adults. Semin Laparosc Surg 2001;
:246-55.
Crankson SJ, Al Jadaan SA, Namshan MA, Al-Rabeeah AA,
Oda O. The immediate and long-term outcomes of newborns
with congenital diaphragmatic hernia. Pediatr Surg Int 2006;
:335-340.
Arca MJ, Barnhart DC, Lelli JL, Greenfeld J, Harmon CM,
Hirschl RB, et al. Early experience with minimally invasive
repair of congenital diaphragmatic hernias: results and lessons
learned. J Pediatr Surg 2003; 38:1563-68.
de Lorimier AA. Diaphragmatic Hernia. In: Pediatric Surgery,
Ashcraft KW, Holder TM, editors, Philadelphia: WB Saunders;
pp. 204-17
Smith HL. Gastro-oesophageal reflux and hiatal hernia in
children. N Z Med J 1980; 92:148-151.
Sakai H, Tamura M, Hosokawa Y, Bryan AC, Barker GA,
Bohn DJ. Effect of surgical repair on respiratory mechanics in
congenital diaphragmatic hernia. J Pediatr 1987; 111:432-38.
Taskin M, Zengin K, Unal E, Eren D, Korman U. Laparoscopic
repair of congenital diaphragmatic hernias. Surg Endosc 2002;
:869.
Rothenberg SS, Chang JH, Bealer JF. Experience with
minimally invasive surgery in infants. Am J Surg 1998;
:654-658.
Kimmelstiel FM, Holgersen LO, Hilfer C. Retrosternal
(Morgagni) hernia with small bowel obstruction secondary to a
Richter's incarceration. J Pediatr Surg 1987; 22:998-1000.
Mishalany HG, Nakada K, Woolley MM. Congenital
diaphragmatic hernias: eleven years' experience. Arch Surg
; 114:1118-1123.
Harrison MR, Adzick NS, Estes JM, Howell LJ. A prospective
study of the outcome for fetuses with diaphragmatic hernia.
JAMA 1994; 271:382-384.
Mirza A, Mansoor SH. Congenital Diaphragmatic Hernia:
Don’t haste Surgery. Ann King Edward Med Coll 1997;
(3):51-53.
Jaillard SM, Pierrat V, Dubois A, Truffert P, Lequien P, Wurtz
AJ, et al. Outcome at 2 years of infants with congenital
diaphragmatic hernia: a population-based study. Ann Thorac
Surg 2003; 75:250-6.
Muratore CS, Kharasch V, Lund DP, Sheils C, Friedman S,
Brown C, et al. Pulmonary morbidity in 100 survivors of
congenital diaphragmatic hernia monitored in a
multidisciplinary clinic. J Pediatr Surg 2001; 36:133-40.
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
