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Congenital diaphragmatic hernia beyond infancy.
Am J Surg. 1991 Dec; 162(6):643-6.AJ

Abstract

Congenital diaphragmatic hernia (CDH) is a common cause of severe respiratory distress in the newborn. However, the presentation of CDH in older children and adults is rare, and, therefore, little is known concerning its symptoms, operative management, and postoperative complications. Thirteen patients (age range: 2 months to 26 years; 5 males, 8 females) presented with CDH. Four patients had right-sided hernias, eight left-sided hernias, and one bilateral hernias. Symptoms included chronic respiratory tract infections in 6 patients, vomiting in 5, weight loss in 1, severe failure to thrive in 2, and severe respiratory distress in 3; one patient was asymptomatic. Physical signs included the absence of breathing sounds or bowel sounds in the chest in eight patients, hyperresonance in one, and cachexia in two. The diagnosis was confirmed in each patient by chest roentgenogram or gastrointestinal contrast radiograph. All patients underwent immediate repair. After reduction of the viscera, 12 of 13 patients underwent primary diaphragm repair, whereas one patient required a prosthetic diaphragm patch. Twelve of 13 patients (92%) survived. Postoperatively, 7 of the 12 survivors (58%) developed severe gastric atony, and four required further operative therapy. In contrast to newborns, CDH in the older child and adult is frequently seen on the right side, rarely presents with severe respiratory distress, and is occasionally asymptomatic. Postoperative gastric atony is a major cause of morbidity, making transabdominal repair with simultaneous pyloroplasty and/or feeding jejunostomy the preferred operative approach.

Authors+Show Affiliations

Department of Surgery, St. Louis University School of Medicine, Missouri.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1670242

Citation

Weber, T R., et al. "Congenital Diaphragmatic Hernia Beyond Infancy." American Journal of Surgery, vol. 162, no. 6, 1991, pp. 643-6.
Weber TR, Tracy T, Bailey PV, et al. Congenital diaphragmatic hernia beyond infancy. Am J Surg. 1991;162(6):643-6.
Weber, T. R., Tracy, T., Bailey, P. V., Lewis, J. E., & Westfall, S. (1991). Congenital diaphragmatic hernia beyond infancy. American Journal of Surgery, 162(6), 643-6.
Weber TR, et al. Congenital Diaphragmatic Hernia Beyond Infancy. Am J Surg. 1991;162(6):643-6. PubMed PMID: 1670242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congenital diaphragmatic hernia beyond infancy. AU - Weber,T R, AU - Tracy,T,Jr AU - Bailey,P V, AU - Lewis,J E, AU - Westfall,S, PY - 1991/12/11/pubmed PY - 2001/3/28/medline PY - 1991/12/11/entrez SP - 643 EP - 6 JF - American journal of surgery JO - Am. J. Surg. VL - 162 IS - 6 N2 - Congenital diaphragmatic hernia (CDH) is a common cause of severe respiratory distress in the newborn. However, the presentation of CDH in older children and adults is rare, and, therefore, little is known concerning its symptoms, operative management, and postoperative complications. Thirteen patients (age range: 2 months to 26 years; 5 males, 8 females) presented with CDH. Four patients had right-sided hernias, eight left-sided hernias, and one bilateral hernias. Symptoms included chronic respiratory tract infections in 6 patients, vomiting in 5, weight loss in 1, severe failure to thrive in 2, and severe respiratory distress in 3; one patient was asymptomatic. Physical signs included the absence of breathing sounds or bowel sounds in the chest in eight patients, hyperresonance in one, and cachexia in two. The diagnosis was confirmed in each patient by chest roentgenogram or gastrointestinal contrast radiograph. All patients underwent immediate repair. After reduction of the viscera, 12 of 13 patients underwent primary diaphragm repair, whereas one patient required a prosthetic diaphragm patch. Twelve of 13 patients (92%) survived. Postoperatively, 7 of the 12 survivors (58%) developed severe gastric atony, and four required further operative therapy. In contrast to newborns, CDH in the older child and adult is frequently seen on the right side, rarely presents with severe respiratory distress, and is occasionally asymptomatic. Postoperative gastric atony is a major cause of morbidity, making transabdominal repair with simultaneous pyloroplasty and/or feeding jejunostomy the preferred operative approach. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/1670242/Congenital_diaphragmatic_hernia_beyond_infancy L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9610(91)90127-Y DB - PRIME DP - Unbound Medicine ER -