• Journal of Chest Surgery
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• v.34 no.12
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• pp.968-971
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• 2001

Pedicled omentoplasty is effective in thoracic surgery, but it is associated with several postoperative complications. A case of diaphragmatic hernia as a complication of pedicled omentoplasty in a 65-year-old male is reported. Because aortoesophageal fistula occurred three months after the patch aortoplasty for mycotic aneurysm of descending thoracic aorta, he underwent ascending thoracic aorta to abdominal aorta bypass surgery with resection of thoracic aortic aneurysm and esophagorrhaphy with wrapping of the esophageal suture line and the stumps of aorta with pedicled omental flap. Three years after the operation, herniation of the stomach developed. The pedicled omental flap was ligated and divided, and the diaphragm defect was repaired.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.456-459
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• 2017

A 66-year-old patient undergoing regular follow-up at Samsung Medical Center after left lower lobectomy visited the emergency department around 9 months postoperatively because of nausea and vomiting after routine esophagogastroduodenoscopy at a local clinic. Abdominal computed tomography showed the stomach herniating into the left thoracic cavity. We explored the pleural cavity via video-assisted thoracic surgery (VATS). Adhesiolysis around the herniated stomach and laparotomic reduction under video assistance were successfully performed. The diaphragmatic defect was repaired via VATS. The postoperative course was uneventful, and he was discharged with resolved digestive tract symptoms.

• Journal of Chest Surgery
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• v.16 no.2
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• pp.221-225
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• 1983

Morgagni, in 1760, 1st. described the findings of substernal herniation of abdominal contents into the thoracic cavity, based upon 25 postmortem dissections. Herniation through the foramen of Morgagni is the rarest occurrence of the congenital diaphragmatic hernias and is usually a few symptoms. With the increasing use of routine chest roentgenogram & the need to exclude the possibility of a mediastinal neoplasm, most such cases are brought to the attention of a surgeon. We had experienced 2 cases of Morgagni hernia, which one caused a simple mechanical intestinal obstruction & diagnosed as acute appendicitis with perforation & another one was diagnosed as mediastinal lipoma on routine chest X-ray film at arrival due to traffic accident. We had performed left paramedian abdominal incision as misdiagnosis of acute appendicitis with perforation and repair of the defect and returned transverse colon & stomach into abdominal cavity in one patient. And in another patient, we preferred to approach through right thoracotomy incision and then left upper paramedian abdominal incision and returned the omentum into the abdominal cavity. The post-operative courses were in uneventful and we report these cases and review and discuss the literatures.

• 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.

• Advances in pediatric surgery
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• v.12 no.1
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• pp.53-69
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• 2006

This is a survey on congenital posterolateral diaphragmatic hernia, conducted by the Korean Association of Pediatric Surgeons(KAPS). A registration form for each patient during the 5-year-period between 1998 and 2002 and a questionaire were sent to each member. Twenty-ninemembers in 22 institutions returned completed forms. The average number of patients per surgeon was 1.4 cases a year. The male to female ratio was 1.64: 1, and annual incidencewas 1/14,522 live births. In this review, factors influencing survival in congenital posterolateral diaphragmatic hernia were age at admission, birth weight, time of antenatal diagnosis, birth place, Apgar score, onset time of symptoms and signs, preoperative cardiopulmonary resuscitation, associated anomalies of themusculoskeletal system, central nervous system, or chromosomes, preoperative stabilization, levels of preoperative $FiO_2$, pH, and $AaDO_2$, perioperative complications, bilaterality of defect, size of the defect, and presence or absence of hernia sac.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.258-260
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• 2023

Traumatic rupture of the right hemidiaphragm occurred following a high-velocity motor vehicle collision in the case presented herein. The resulting herniation of small bowel loops into the thorax resulted in hemodynamic and respiratory compromise due to pressure effects on the right heart and major vessels. The patient's hemodynamic status improved with reduction of enterothorax, and the diaphragmatic defect was repaired. We discuss the available literature and learning points from this rare case.

• Journal of Chest Surgery
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• v.50 no.4
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• pp.298-299
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• 2017

We report the case of a 17-year-old girl who presented with an indentation in the right ventricle caused by an incomplete pericardium on preoperative 3-dimensional reconstructed computed tomography. She was to undergo surgery for a partial atrioventricular septal defect and secundum atrial septal defect. Preoperative electrocardiography revealed occasional premature ventricular beats. We found the absence of the left side of the pericardium intraoperatively, and this absence caused strangulation of the diaphragmatic surface of the right ventricle. After correcting the lesion, the patient's rhythm disturbances improved.

• Neonatal Medicine
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• v.25 no.3
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• pp.102-108
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• 2018

Purpose: Congenital diaphragmatic hernia (CDH) is rare but potentially fatal. The overall outcome is highly variable. This study aimed to identify a simple and dynamic parameter that helps predict the mortality of CDH patients in real time, without invasive tests. Methods: We conducted a retrospective chart review of 59 CDH cases. Maternal and fetal information included the gestational age at diagnosis, site of defect, presence of liver herniation, and lung-to-head ratio (LHR) at 20 to 29 weeks of gestational age. Information regarding postnatal treatment, including the number of days until surgery, the need for inhaled nitric oxide (iNO), the need for extracorporeal membrane oxygenation (ECMO), and survival, was collected. The highest respiratory severity score (RSS) within 24 hours after birth was also calculated. Results: Statistical analysis showed that a younger gestational age at the initial diagnosis (P<0.001), a lower LHR (P=0.001), and the presence of liver herniation (P=0.003) were prenatal risk factors for CDH mortality. The RSS and use of iNO and ECMO were significant factors affecting survival. In the multivariate analysis, the only remaining significant risk factor was the highest preoperative RSS within 24 hours after birth (P=0.002). The area under the receiver operating characteristic curve was 0.9375, with a sensitivity of 91.67% and specificity of 83.87% at the RSS cut-off value of 5.2. The positive and negative predictive values were 82.14% and 92.86%, respectively. Conclusion: Using the RSS as a prognostic predictor with simple calculations will help clinicians plan CDH management.

• Advances in pediatric surgery
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• v.7 no.1
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• pp.21-25
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• 2001

Congenital diaphragmatic hernia (CDH) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant. conventional mechanical ventilation. high frequency oscillation. and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (${\leq}$ 8 hours and > 8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%. p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%. p=0.031). The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia. no liver herniation, or shorter preoperative stabilization period.

• Journal of Chest Surgery
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• v.6 no.1
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• pp.109-112
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• 1973

Bochdalek hernia is the most common congenital diaphragmatic hernia and that of the foramen of Bochdalek is rare in right side of the diaphragm. Two cases of right Bochdalek hernia were reported in literatures published in Korea. The first case was associated with hypoplasia of the lung and could not be survived. The second case [four months old male infant] was operated on August 28, 1971. at Ewha University Hospital arid survived. The third case was a three months old male infant who had been born at 8th lunar month in a private clinic. During the period of three months prior to admission this premature infant was suf-fered from mild respiratory distress measured as pneumonia. On December 20. 1972, this infant was admitted at Kyung Hee University Hospital with severe respiratory distress developed abruptly. Chest X-ray examination [barium study] demonstrated right diaphragmatic hernia. Right hemithorax was filled with intestines and right lobe of the liver which were repositioned back into the peritoneal cavity through the foramen of Bochdalek. 3. 0 cm x3.5 cm in size, and the defect was closed with interrupt mattress sutures. There was hypospadia with chordee but no other associated anomalies such as hypoplasia of the lung, malrotation or malfixation of intestines, and cardiovascular anomalies. The Postoperative hospital course was not eventful and the baby was discharged on the 14th postoperative day.