Pitfalls in the diagnosis of congenital diaphragmatic hernia

Article Abstract:

A hernia is a rupture or tear in an organ or body tissue. Congenital diaphragmatic hernia (CDH) is a type of hernia that is present in infants at birth. It is caused by a defect or tear in the outer membrane of the diaphragm. This allows a portion of the intestine and stomach to move upward into the space between the lungs and rib cage (pleural cavity). When this happens, the stomach and intestines press against the lungs and cause the heart to be pushed to the opposite side. When these organs press against the lungs they can make breathing difficult and may cause symptoms of lung disease. CHD is rare, estimated to occur in 1 out of every 2,200 live births. It can be diagnosed using chest X-rays and ultrasound imaging of the abdomen. In some cases of CHD the hole in the diaphragm may be plugged by the liver or spleen. In these cases CHD can be tricky to diagnose because the chest X-rays appear normal, and X-rays or ultrasound of the abdominal area will be required for a correct diagnosis. Also, chest X-rays of patients with advanced pneumonia caused by an infection with staphylococcus bacteria can look like those in patients with CHD. CHD is less common in older children than it is in infants. It is estimated that only 5 to 25 percent of the cases of CHD occur in older children. When CHD appears in children it is more difficult to diagnose because it is associated with a wider variety of nonspecific symptoms, including recurrent chest infections, difficulty breathing, vomiting, and diarrhea or constipation. Chest X-rays may appear normal in children as well, and in these cases abdominal X-rays or ultrasound will be required. The usual treatment for CHD is surgery to repair the hernia in the diaphragm. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diagnosis

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Preoperative stabilisation in congenital diaphragmatic hernia

Article Abstract:

A congenital diaphragmatic hernia is a defect caused by the failure of the membrane that normally separates the peritoneal (abdominal) cavity from the pleural cavity (where the lungs are located) to develop properly. As a consequence, the abdominal organs (intestine, stomach, spleen) move into the pleural cavity, compressing the lungs and heart. Although repair of such hernias is usually performed on an emergency basis, the necessity for emergency measures has not really been shown. In fact, too-early surgery may place stress on a patient who is already unstable; it may be preferable to wait until stabilization (of breathing, gas exchange, acid-base balance) has occurred. To evaluate this, two groups of patients who underwent surgery to repair their congenital diaphragmatic hernias were studied. In the first group (26 patients), patients underwent emergency repair; in the second (23), repair was performed only after stabilization had occurred (average, 7 hours after birth). There was no significant difference between the groups in the proportion of infants who died before the procedure (19 and 30 percent, respectively, in groups 1 and 2), nor in survival rates afterwards (54 and 48 percent). The most important factors in predicting recovery from this condition in neonates are pulmonary hypoplasia (insufficient growth of the lungs) and pulmonary hypertension (increased pressure in the pulmonary artery, which takes blood from the heart to the lungs). Good cardiopulmonary support is essential for survival. The results indicate that delay in repair of congenital diaphragmatic hernias does not lead to a poorer outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgery, Diseases, Neonatal diseases, Hernia repair

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Congenital diaphragmatic hernia: impact of prostanoids in the perioperative period

Article Abstract:

Congenital diaphragmatic hernia is a birth defect in which a portion of the diaphragm is pushed through the wall surrounding the cavity that contains it. This disorder is associated with underdevelopment of the lungs and persistent pulmonary hypertension (PPH), or high blood pressure within the lungs. Substances formed from the breakdown of naturally occurring arachidonic acid, such as prostanoids, are thought to be involved in the development of PPH in newborns. The importance of prostanoid levels during surgery to repair the hernia and their relation to PPH were assessed in 10 newborns with congenital diaphragmatic hernia and five normal subjects. The results show that the levels of the prostanoid thromboxane B2 increased after surgery in newborns with the congenital defect and were higher during attacks of PPH. This rise in the levels of thromboxane, which constricts blood vessels, may trigger PPH and subsequent right to left shunting, or flow of blood from the right to left side of the heart through an abnormal passage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Prostanoids

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