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Iatrogenic anterior diaphragmatic hernia in childhood

M Bettolli1, C-C Jackson, B Sweeney

  • 1Division of Pediatric General Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|July 17, 2008
PubMed

Insights

Iatrogenic anterior diaphragmatic hernias (ADH) are a rare complication in children following cardiac surgery. This report highlights two pediatric cases successfully treated with laparoscopy, emphasizing early diagnosis and intervention.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Surgical Complications

Background:

  • Congenital anterior diaphragmatic hernias (ADH) are uncommon, and acquired ADH are rare, typically resulting from trauma.
  • Iatrogenic ADH, particularly in childhood, is exceptionally rare.
  • Subxiphoid pericardial drains, used post-cardiac surgery, are identified as a potential cause of iatrogenic ADH.

Purpose of the Study:

  • To report the first cases of iatrogenic anterior diaphragmatic hernia in childhood.
  • To highlight the association between subxiphoid pericardial drains and ADH development.
  • To emphasize the diagnostic and therapeutic utility of laparoscopy for iatrogenic ADH.

Main Methods:

  • Case report of two pediatric patients diagnosed with asymptomatic iatrogenic ADH.
  • Diagnostic imaging included incidental chest X-ray and intraoperative findings during laparoscopic-assisted gastrostomy.
  • Surgical repair was performed using a laparoscopic approach.

Main Results:

  • Two children, aged 6 and 12 months, presented with asymptomatic iatrogenic ADH after cardiac surgery with pericardial drainage.
  • ADH was incidentally discovered in one patient and during a gastrostomy procedure in the other.
  • Both cases of iatrogenic ADH were successfully managed with laparoscopic repair.

Conclusions:

  • Subxiphoid pericardial drains can lead to iatrogenic anterior diaphragmatic hernias in pediatric patients.
  • A high index of suspicion is crucial for diagnosing ADH in children post-cardiac surgery.
  • Laparoscopy is an effective method for both diagnosing and repairing iatrogenic ADH in this population.

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