• Journal of Chest Surgery
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• v.34 no.2
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• pp.184-188
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• 2001

선천성 횡경막탈장은 2000∼5000명의 신생아 당 한명 꼴의 발생율을 가진 드문 질환이다. 그 중 신생아에서 열공탈장은 더욱 희귀한 질환이다. 저자는 생후 1주일된 신생아의 선천성 복합열공탈장을 경험하였다. 진단은 빠른 시간내 이루어졌으며 수술은 우측 흉곽절제술을 통해 탈장된 장기를 복원하고 Belsey-mark IV 술식을 시행하였다. 환아는 술후 3일째 음식을 먹었고 퇴원 6개월후 지금까지 별 문제없이 잘 지내고 있다.

• Neonatal Medicine
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• v.16 no.1
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• pp.64-70
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• 2009

Congenital diaphragmatic hernia (CDR) with severe pulmonary hypoplasia is associated with significant mortality. Recently, several new therapeutic methods have been suggested, such as high-frequency oscillatory ventilation and inhaled nitric oxide. For hypoxemic respiratory failure unresponsive to these advanced medical treatment options, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment. An understanding of the pathophysiology of pulmonary hypertension associated with CDH led to a strategy involving preoperative stabilization and delayed surgical intervention with ECMO. We describe four cases of ECMO, including the first report of ECMO for neonatal CDH in Korea.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.246-250
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• 2009

Congenital diaphragmatic hernias (CDH) usually cause respiratory distress soon after birth and are associated with a high mortality rate in the early postnatal period. However, there is a milder form of CDH that does not manifest during the neonatal period. The late presenting CDH is characterized by a variable clinical picture. We present the case of an otherwise healthy 5-month-old girl, who was referred for evaluation of an 1-day history of vomiting and irritability. Chest simple X-ray and CT showed bowel loops in the left thoracic cavity, which was consistent with diaphragmatic hernia. At operation, she was found to have a small left posterolateral diaphagmatic defect with viable small bowel loops in the left thoracic cavity. After surgical reposition of the hernia, the symptoms such as vomiting and irritability subsided. The lack of typical manifestation of CDH such as respiratory distress may lead to delayed diagnosis. The possibility of late presenting CDH should not be overlooked even after the neonatal period.

• Journal of Chest Surgery
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• v.7 no.1
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• pp.127-132
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• 1974

Reported here is a 18-day old infant who had sufferred from congenital left Bochdalek hernia associated with malrotation of stomach, spleen, portions of colon and small intestine. Surgical treatment was successful. The review of the literature was done.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.573-578
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• 2006

Background: Generally hernia is diagnosed with simple chest or gastrointestinal x-ray. Sometimes CT or MRI can give lots of information for the diagnosis. However, there was no study for the differentiation with using CT findings between Morgagni hernia and pleuropericardial fat. The aim of this study was to evaluate the useful CT findings for differentiating Morgagni hernia from pleuropericardial fat. Material and Method: We retrospectively analyzed CT scans of eight patients with Morgagni hernia and 20 patients with abundant pleuropericardial fat without peridiaphragmatic lesions. All CT scans were performed with coverage of the whole diaphragm in the inspiration state. We evaluated 1) the presence of the defect of the anterior diaphragm, 2) the interface between the lung and fat, 3) the angle between the chest wall and fat, 4) the continuity between the extrapleural fat and fat, 5) the presence of the vessels within fat, and 6) the presence of a thin line surrounding fat. Result: In all cases with Morgagni hernia, the defect of the anterior diaphragm was seen. The interface was well-defined, smooth, and convex to the lung. The angle with the chest wall was acute. The continuity with the extrapleural fat was not seen. In the cases with abundant pleuropericardial fat, the defect of the anterior diaphragm was seen in three (15%). The interface was usually irregular (n=10) and flat (n=17). The angle with the chest wall was variable. The continuity with the extrapleural fat, that was markedly increased in amount, was usually seen (n=16). The thin line surrounding fat was seen in four cases with Morgagni hernia, however, not seen in all cases with pleuropericardial fat. All of the above findings were statistically significant, however, vessels within fat was not significant to differentiate Morgagni hernia (n=8/8) from pleuropericardial fat (n=14/20). Conclusion: The useful CT findings of Morgagni hernia were fatty mass with sharp margin, convexity toward lung, acute angle with chest wall, and thin line surrounding hernia. Branching structure within fatty mass representing omental vessels that has been known as a characteristic finding of Morgagni hernia was not useful for differentiating Morgagni hernia from pleuropericardial fat.

• Journal of Chest Surgery
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• v.28 no.9
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• pp.837-841
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• 1995

Between June 1981 and April 1994, 15 patients underwent surgical repair of diaphragmatic hernia. The ages ranged from 1 day to 60 years, with a mean age of 34. There were 5 cases of congenital diaphragmatic hernia; Bochdalek hernia in 4 cases and Morgagni hernia in 1 case. There were 10 cases of traumatic diaphragmatic hernia;blunt trauma in 8 cases and stab wounds in 2 cases. The chest X-ray findings were abnormal in 10 cases. Operations were performed in all patients and there was only one death, who was a newborn with left Bochdalek hernia and pulmonary hypoplasia.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.851-854
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• 1987

Congenital diaphragmatic hernia remains a disease with high neonatal mortality rate despite recent advance in neonatal intensive care. We experienced one case of the congenital diaphragmatic hernia with acute respiratory distress and left pulmonary hypoplasia in the neonate. The simple closure was performed through left paramedian approach after diagnosis. The postoperative course was uneventful except wound disruption. The patient was follow-up with good general condition.

• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1123-1126
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• 2008

A lung hernia, defined as the protrusion of pulmonary tissue and pleural membranes through a defect in the thoracic wall, is a rare event. It can be congenital or acquired, and cervical, thoracic, or diaphragmatic in location. We report the rare occurrence of a congenital atraumatic lung herniation through the azygoesophageal recess. An 8-month-old male infant, who was born at 35 weeks gestation, had a chronic cough. Chest radiography showed haziness at the right lower lobe of the lung (RLL). Chest computed tomography (CT) revealed herniation of the RLL through the azygoesophageal recess. If persistent unilateral haziness is observed on chest radiography, the possibility of lung herniation should be considered.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.175-183
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• 1988

Congenital diaphragmatic hernia [CDH] is a surgical emergency in the newborn infant because it causes severe cardiorespiratory distress. Congenital diaphragmatic eventration [CDE] may also produce severe cardiorespiratory distress in the newborn infant. CDH is an anatomically simple defect that can be easily repaired by reduction of the displaced viscera from the pleural cavity and closure of the diaphragmatic defect. But these infants mortality has not been reduced and still remains very high. The barrier to survival is pulmonary parenchymal and vascular hypoplasia as well as the complex syndrome of persistent fetal circulation. Between May, 1985 and Oct, 1987, 4 neonates with CDH and 1 neonate with CDE were seen in respiratory distress within 12 hrs of birth at St. Francisco general hospital. Each had severe acidosis and hypoxia. And was transferred from a local clinic. They were surgically repaired within 24 hrs of birth. Three neonates lived and two died. Two of the three neonates with CDH operated in the first 6 hrs died. The remaining two [one with CDH, the other with CDE] operated between 6hrs and 24 hrs lived. One case of mortality was combined with bilateral pulmonary hypoplasia and contralateral pneumothorax. The other one case of mortality was combined with complex syndrome of persistent fetal circulation after honeymoon period.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.400-402
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• 2005

Herniation of the kidney through a traumatic diaphragmatic rupture in itself is rare. However, complete avulsion of the renal pedicle implies not only a more rare event, but also a surgical emergency. We report a case of a patient with complete avulsion of renal vessels and ureter of an intrathoracic kidney herniated through a diaphragmatic rupture caused by blunt trauma. Prompt diagnosis with a computer tomographic scan and immediate surgery saved the patient's life.