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Congenital diaphragmatic hernia beyond infancy.
T R Weber1, T Tracy, P V Bailey
1Department of Surgery, St. Louis University School of Medicine, Missouri.
American Journal of Surgery
|December 11, 1991
Summary
Congenital diaphragmatic hernia (CDH) in older patients presents differently than in newborns, often with fewer respiratory issues. Postoperative gastric atony is a significant complication requiring specific surgical approaches.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Gastroenterology
Background:
- Congenital diaphragmatic hernia (CDH) is a frequent cause of neonatal respiratory distress.
- CDH presentation, management, and complications in older children and adults are less understood.
Purpose of the Study:
- To investigate the clinical presentation, surgical management, and outcomes of CDH in non-newborn patients.
- To identify common symptoms, diagnostic methods, and postoperative complications in this rare demographic.
Main Methods:
- Retrospective review of 13 patients (2 months to 26 years) with congenital diaphragmatic hernia.
- Analysis of patient symptoms, physical signs, diagnostic imaging (chest roentgenogram, GI contrast radiograph), surgical repair techniques, and postoperative complications.
Main Results:
- CDH in older patients often presents with chronic respiratory infections or gastrointestinal issues, rarely severe respiratory distress.
- Right-sided hernias were more common in this cohort (4/13), contrasting with neonatal CDH.
- 92% survival rate, but 58% of survivors experienced severe postoperative gastric atony, necessitating further surgery.
Conclusions:
- Congenital diaphragmatic hernia in older children and adults has distinct clinical features compared to neonates.
- Postoperative gastric atony is a major morbidity, supporting transabdominal repair with pyloroplasty or feeding jejunostomy as preferred surgical strategies.