Giant Bochdalek Hernia: A Minimally Invasive Transabdominal Approach

A Bochdalek hernia is the most common congenital diaphragm hernia (CDH). It can rarely evade prenatal detection and persist into adulthood with minimal symptoms. Large CDH repair has often required an open approach in the past. In this article, we present a case of a patient with large CDH who was asymptomatic until later in her adult life who subsequently developed symptoms and sought a surgical evaluation. A minimally invasive transabdominal approach was used to effectively reduce and repair this rare giant hernia. The patient has remained free of recurrence and has had resolution of her symptoms after 18 months of follow-up. This case illustrates that even the largest of these can be handled in a minimally invasive fashion and achieve durable results.

SURGICAL TECHNIQUES FOR TREATMENT OF COMPLICATED LARGE SIZE TRAUMATIC DIAPHRAGM HERNIA (CLINICAL CASE ANALYSIS)

The analysis of a clinical case of surgical treatment of a traumatic hernia of the left cupola of the diaphragm in a patient 66 years old, diagnosed 5 years after injury. The hernia was complicated by bowel perforation, gastrointestinal and cardiorespiratory syndrome due to organ translocation into the pleural cavity. Are noted the features of complications of traumatic hernias in the late period of their occurrence and associated diagnostic methods. The stages of diagnostics and treatment of this patient from the central district hospital to the regional clinical hospital have been analyzed; are presented the algorithm and methods of surgical treatment, the features of the postoperative period.The Department of Surgery No. 1 of the BSMU has extensive experience in the treatment of complicated diaphragm hernias, on the basis of which the article substantiates the indications for decompression of the mediastinal organs, gives the causes of pneumothorax, surgical techniques for its correction.Also are analyzed the types of surgical approaches for this pathology were are indicated the advantages and disadvantages of isolated laparotomy, thoracotomy, combined thoracoabdominal interventions.

Resolution of Chronic Shoulder Pain after Repair of a Posttraumatic Diaphragmatic Hernia: A 22-Year Delay in Diagnosis and Treatment

Diagnosing traumatic diaphragmatic rupture (TDR) due to penetrating rib fractures is challenging because the lesions are often too small to be detected and may present years after injury. Patients with delays in diagnosis of TDR rarely present with orthopaedic-related complaints of pain. We report the case of a 52-year-old female who presented with chronic left shoulder pain following a motor vehicle accident (MVA). In addition to left-side lower rib fractures, she also sustained a left-sided splenic laceration, pneumothorax, and two-part upper humerus fracture. Fracture treatment was percutaneous pinning; the other injuries were treated nonoperatively. Her shoulder pain could not be attributed to shoulder or neck pathology. Twenty years after the MVA, she began experiencing episodes of left-sided abdominal pain and nausea. A CT scan obtained two years later revealed a diaphragm hernia, which was repaired laparoscopically. Unique aspects of this case include (1) presentation to an orthopaedic surgeon with a chief complaint of chronic shoulder pain; (2) at 22 years, this is the fourth longest case of a delay in diagnosis of TDR; and (3) the unique symptom of ipsilateral referred shoulder pain, which immediately improved after hernia repair.

Outcomes of Cases of Prenatally-Diagnosed Congenital Pulmonary Airway Malformation

Objective To evaluate the outcomes of cases of prenatally-diagnosed congenital pulmonary airway malformation (CPAM). Methods We retrospectively evaluated cases of prenatally-diagnosed CPAM between 2004 and 2018. Ultrasonographic features such as visualization of a fetal lung mass and heterogeneous pulmonary parenchyma were used for CPAM diagnosis. Prenatal and postnatal findings were compared in terms of accuracy regarding the CPAM diagnosis. Results The sample consisted of 27 cases. There were four cases in which the patients opted for the termination of pregnancy due to the severity of the lesion. A total of 23 neonates were delivered, and CPAM was confirmed in 15 cases. The median gestational age at delivery was 37 weeks (28–40 weeks) and the mean birth weight was 2,776 g. There were two neonatal deaths, one due to pneumothorax, and the other due to hypoplastic left heart syndrome (HLHS). A total of five patients with respiratory problems were operated in the postpartum period. There were eight misdiagnosis: bronchopulmonary sequestration (five cases), congenital lobar emphysema (two cases), and congenital diaphragm hernia (one case). Conclusion A precise postnatal diagnosis is very important to organize the proper management of the pregnancies with fetuses with CPAM. The positive predictive value of the prenatal diagnosis of CPAM via ultrasonography is of 70.3%. The differential diagnosis of CPAM may be prolonged to the postpartum period in some cases.

TORACOSCOPIC TREATMENT OF THE NEWBORN INFANT WITH FALSE RIGHT-SIDED DIAPHRAGM HERNIA

Congenital diaphragmatic hernia (CDH) occurs with a frequency of 1 per 2000 - 4000 live births, but at present, surgical treatment of EDC, especially in newborns, remains one of the difficult tasks of pediatric surgeons, anesthesiologists, and resuscitators. The numbers of postoperative lethality can reach high values, 35-50% of children die from surgery, besides, 32% of CDH children are born dead. The highest mortality rate is characteristic for agenesia of the diaphragm dome. False CDHs are more common, in one-sided cases left-sided defects in the diaphragm prevail occurring 4-16 times more often. The authors presented their own experience - a description of a rare clinical case of right-sided false diaphragmatic hernia in a newborn infant and its successful thoracoscopic treatment.