Tags

Type your tag names separated by a space and hit enter

Primary paraesophageal hernia in children.
J Pediatr Surg. 2006 Sep; 41(9):1588-93.JP

Abstract

BACKGROUND

Paraesophageal hernias are uncommon in children and are distinctively different from the more common sliding hiatus hernias and those occurring after antireflux surgery in anatomy, pathology, symptoms, complications, and management. We reviewed a single institution's experience with the pathology of paraesophageal hernias.

METHODS

We conducted a retrospective analysis of patient records.

RESULTS

Fifty-nine children with paraesophageal hernias were treated during a 42-year period. Their mean age at presentation was 23.4 months (range, 1 day to 11 years). Presenting complaints were recurrent chest infections (n = 32), vomiting (n = 24), symptomatic anemia (n = 20), failure to thrive (n = 18), and dysphagia (n = 6). Five children were asymptomatic, and their diagnosis was established when they were investigated for incidentally noted asymptomatic anemia (n = 3), scoliosis (n = 2), and mumps (n = 1). Radiology typically showed cystic masses in the posterior mediastinum in the right lower chest and occasionally had an air-fluid level in the cystic mass or a dilated esophagus. None presented with strangulation or hematemesis. All patients were operated on. Surgical findings included a peritoneal lined sac and herniation through a widened diaphragmatic hiatus, containing the stomach and at times the transverse colon, spleen, and small bowel. The hernial sac usually occurred on the right. Principles of surgery included reduction of the contents, partial excision of the sac, crural approximation, and a fundoplication in 39 patients. No fundoplication was done in the earlier years in 20 patients, of whom 12 had recurrent reflux symptoms. Postoperative complications were bowel obstruction (n = 6), intussusception (n = 3), dysphagia (n = 3), breakdown of the repair (n = 3), and pneumothorax (n = 1). There was one mortality caused by preoperative aspiration.

CONCLUSION

Paraesophageal hernias in children are uncommon and most likely caused by a congenital defect. They are associated with considerable morbidity. Strangulation is not a feature. Principles of repair are well established and should include an antireflux procedure.

Authors+Show Affiliations

Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town 7700, South Africa.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16952596

Citation

Karpelowsky, Jonathan S., et al. "Primary Paraesophageal Hernia in Children." Journal of Pediatric Surgery, vol. 41, no. 9, 2006, pp. 1588-93.
Karpelowsky JS, Wieselthaler N, Rode H. Primary paraesophageal hernia in children. J Pediatr Surg. 2006;41(9):1588-93.
Karpelowsky, J. S., Wieselthaler, N., & Rode, H. (2006). Primary paraesophageal hernia in children. Journal of Pediatric Surgery, 41(9), 1588-93.
Karpelowsky JS, Wieselthaler N, Rode H. Primary Paraesophageal Hernia in Children. J Pediatr Surg. 2006;41(9):1588-93. PubMed PMID: 16952596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary paraesophageal hernia in children. AU - Karpelowsky,Jonathan S, AU - Wieselthaler,Nicky, AU - Rode,Heinz, PY - 2006/9/6/pubmed PY - 2006/9/30/medline PY - 2006/9/6/entrez SP - 1588 EP - 93 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 41 IS - 9 N2 - BACKGROUND: Paraesophageal hernias are uncommon in children and are distinctively different from the more common sliding hiatus hernias and those occurring after antireflux surgery in anatomy, pathology, symptoms, complications, and management. We reviewed a single institution's experience with the pathology of paraesophageal hernias. METHODS: We conducted a retrospective analysis of patient records. RESULTS: Fifty-nine children with paraesophageal hernias were treated during a 42-year period. Their mean age at presentation was 23.4 months (range, 1 day to 11 years). Presenting complaints were recurrent chest infections (n = 32), vomiting (n = 24), symptomatic anemia (n = 20), failure to thrive (n = 18), and dysphagia (n = 6). Five children were asymptomatic, and their diagnosis was established when they were investigated for incidentally noted asymptomatic anemia (n = 3), scoliosis (n = 2), and mumps (n = 1). Radiology typically showed cystic masses in the posterior mediastinum in the right lower chest and occasionally had an air-fluid level in the cystic mass or a dilated esophagus. None presented with strangulation or hematemesis. All patients were operated on. Surgical findings included a peritoneal lined sac and herniation through a widened diaphragmatic hiatus, containing the stomach and at times the transverse colon, spleen, and small bowel. The hernial sac usually occurred on the right. Principles of surgery included reduction of the contents, partial excision of the sac, crural approximation, and a fundoplication in 39 patients. No fundoplication was done in the earlier years in 20 patients, of whom 12 had recurrent reflux symptoms. Postoperative complications were bowel obstruction (n = 6), intussusception (n = 3), dysphagia (n = 3), breakdown of the repair (n = 3), and pneumothorax (n = 1). There was one mortality caused by preoperative aspiration. CONCLUSION: Paraesophageal hernias in children are uncommon and most likely caused by a congenital defect. They are associated with considerable morbidity. Strangulation is not a feature. Principles of repair are well established and should include an antireflux procedure. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/16952596/Primary_paraesophageal_hernia_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(06)00371-X DB - PRIME DP - Unbound Medicine ER -