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Published on: April 17, 2019
Massive hiatal hernia in children
A L al-Arfaj1, M S Khwaja, P Upadhyaya
1Department of Surgery, College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia.
Insights
Pediatric massive hiatal hernias present differently than in adults, with vomiting and anemia being common symptoms. Surgical repair outcomes in children require careful consideration of congenital anomalies and prompt diagnosis to prevent complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Abnormalities
Background:
- Massive hiatal hernias in children present unique clinical challenges compared to adults.
- Understanding these differences is crucial for timely diagnosis and effective management.
- Congenital abnormalities frequently coexist with pediatric hiatal hernias.
Purpose of the Study:
- To describe the clinical presentation, associated anomalies, and outcomes of massive hiatal hernias in pediatric patients.
- To compare pediatric presentation and complications with adult counterparts.
- To evaluate the effectiveness of surgical repair in this cohort.
Main Methods:
- Retrospective review of ten pediatric patients undergoing massive hiatal hernia repair between 1982 and 1991.
- Analysis of clinical symptoms, diagnostic methods (including barium meal), surgical procedures (Nissen fundoplication, hiatus repair), and postoperative complications.
- Correlation of outcomes with associated congenital malformations and diagnostic delays.
Main Results:
- Vomiting and anemia were the most frequent presenting symptoms (n=7 each), followed by respiratory distress (n=5).
- Abdominal pain was an uncommon symptom.
- Nissen fundoplication was the most common surgical approach (n=7). Five patients experienced postoperative complications, and two deaths occurred, likely due to diagnostic delays and comorbidities.
Conclusions:
- Pediatric massive hiatal hernias exhibit distinct clinical features and complications compared to adults.
- Prompt diagnosis and surgical intervention are vital to minimize morbidity and mortality.
- Associated congenital anomalies significantly impact patient outcomes.
Abstract:
Ten children had massive hiatal hernias repaired between January 1982 and February 1991. Their clinical presentation, association with other congenital abnormalities, and postoperative complications were different from those seen in adults. Vomiting (n = 7) and anaemia (n = 7) were the most common symptoms, followed by respiratory distress (n = 5), cough (n = 3), and regurgitation (n = 3). Abdominal pain was uncommon. The clinical diagnosis was confirmed in seven cases by barium meal examination. The most common operation was Nissen's fundoplication (n = 7); the hiatus alone was repaired in the remainder. Five patients developed postoperative complications and two died probably as a result of delay in diagnosis and associated malformations.
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