Bochdalek hernias in infants:Factors determining mortality

Adelman, Susan; Benson, Clifford D.

doi:10.1016/s0022-3468(76)80015-2

Cited by 58 publications

(14 citation statements)

References 7 publications

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“…The prognosis in neonatal CDH remains a disturbing question. Of the many factors which are known to influence the outcome of management, the age at diagnosis (< 6 hours) and the preoperative blood gas values (pH ≤ 7.0, PCO2≥ 60 torr, and P02≤ 80 torr) are the most frequently reported predictors of poor outcome [3,4,7]. These observations were also confirmed in this series.…”

Section: Discussionsupporting

confidence: 80%

Congenital Diaphragmatic Hernia: Update on Regional Experience

et al. 1991

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A consecutive series of 34 patients with congenital diaphragmatic hernia are reported from a tertiary neonatal care unit in the Eastern Province. All the patients presented within the first 24 hours of life with left-sided defect. The overall mortality (56%) and postoperative mortality (44%) are comparable with reports from other centers. The outcome of treatment correlated well with the age on presentation, the size of the defect, and preoperative blood gas results. Our approach to management has been modified lately, in the light of recent experience from other centers. The surgery is delayed until the neonate is stabilized with biochemical values of PaCO 2 = 45 torr or less; pH = 7.2 or higher; and PaO 2 = 50 torr or more. This management policy did not adversely affect overall survival. The problems encountered with patient transfer and the need for continued improvement in the organization of regionalized care are highlighted.

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Section: Discussionsupporting

confidence: 80%

Congenital Diaphragmatic Hernia: Update on Regional Experience

et al. 1991

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“…Bochdalek hernia, which is a type of congenital diaphragmatic hernia, involves prolapse of abdominal organs into the thoracic cavity through a diaphragmatic defect that arises due to failed closure of the pleuroperitoneal opening during the fetal period [1][2][3] . The condition was first reported in 1848 by the Czech anatomist Victor Alexander Bochdalek and accounts for 75-85% of all congenital diaphragmatic hernias…”

Section: Discussionmentioning

confidence: 99%

“…Bochdalek hernia is usually diagnosed during the neonatal period. It presents with severe respiratory and circulatory disorders, so the mortality rate is high [1][2][3] . The currently reported prevalence of congenital dia- phragmatic hernia in Europe is 2.3 per 10,000 births 31) .…”

Section: Discussionmentioning

confidence: 99%

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Bochdalek Hernia in Adults: A Report of Two Cases with a Review of the Japanese Literature

Mikami

Fukunaga

Enomoto

et al. 2015

J St. Marianna Univ

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We describe 2 challenging adult cases of Bochdalek hernia. The first case is that of a 22-year-old man who presented with left upper abdominal pain. The second case is that of a 36-year-old man who reported coughing after eating. In both cases, computed tomography revealed a defect in the left posterior attachment of the diaphragm. There was no vesical hernia, but parts of the greater omentum had prolapsed into the thoracic cavity in the first case, and parts of stomach, small intestine, colon, kidney, pancreas, and spleen had prolapsed into the thoracic cavity in the second case. In the first case, we were able to close the hernia defect with sutures by means of thoracoscopic surgery, and in the other case, that of a massive hernia, closure by means of laparoscopic surgery was difficult. We converted to laparotomy to perform suture closure, and we added a mesh patch.Bochdalek hernia is a congenital diaphragmatic defect that is usually apparent in the neonatal period. Discovery of a Bochdalek hernia in an adult is rare. Surgical treatment is necessary, but there are different approaches. Selection of the appropriate procedure depends the advantage to be gained by one approach over another in each particular case. The number of reports on thoracoscopic and laparoscopic surgery for treatment of Bochdalek hernia have increased in recent years. We think that endoscopic surgery for Bochdalek hernia will increase in popularity due to improvements in techniques and devices. We describe our 2 cases in detail and review our experience in light of the available Japanese literature.

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“…15,16 If associated anomalies are excluded in patients with congenital diaphragmatic hernia, the main determinant factors of outcome are the age at presentation (<6 hours) and the preoperative blood gases. 2,3,17,18 Several investigators have proposed extended preoperative medical stabilization, followed by delayed repair. The aim of the extended period of preoperative stabilization is to decrease the pulmonary vascular resistance, improve and stabilize the patient in terms of adequate ventilation (that is, improving oxygenation, eliminating the hypercarbia and acidosis), and improve cardiovascular stability.…”

Section: Discussionmentioning

confidence: 99%

Congenital Diaphragmatic Hernia: The Impact of Preoperative Stabilization on Outcome

et al. 1999

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Despite the fact that it is diagnosed antenatally, and despite the availability of improved intensive care, congenital diaphragmatic hernia (CDH) is still associated with high mortality. [1][2][3] To overcome this problem, a variety of techniques have been proposed to decrease the pulmonary vascular resistance, and correct the hypoxia, acidosis and hypotension. These include in utero surgical repair, 4 introduction of extracorporeal membrane oxygenation, 5,6 and an extended period of preoperative stabilization. [7][8][9][10][11][12] Several investigators have proposed extended preoperative medical stabilization followed by delayed repair, but the results of such an approach in terms of overall outcome are controversial. [10][11][12] This report represents our experience with the management of 47 patients with congenital diaphragmatic hernia and analyzes the effect of preoperative stabilization on outcome. Patients and MethodsThis is a retrospective study of all patients admitted since 1982 to Tawam Hospital, Al-Ain, United Arab Emirates, with the diagnosis of congenital diaphragmatic hernia. The medical records of these patients were reviewed for age at presentation, sex, gestational age, birth weight, whether born at Tawam Hospital or referred from another hospital, associated anomalies, type and site of hernia, contents of the hernia, preoperative and postoperative management, blood gas parameters and outcome. The blood gases, as well as the alveolar arterial O 2 gradient (AaDO 2 =[173xFiO 2 ] -[PaCO 2 /0.8] -PaO 2 ) were analyzed in terms of outcome. The effect of preoperative stabilization, as well as changes in blood gas parameters, were also analyzed using Student's t-test. In the stabilized group, surgery was delayed in an attempt to achieve a pH of more than 7.2, PO 2 of greater than 50 torr, and PCO 2 of less than 50 torr.After evaluation at the Intensive Care Unit, endotracheal intubation was performed when indicated, and the patients were ventilated, using positive pressure ventilation (PPV) to start with, and positive end expiratory pressure (PEEP). Chest and abdominal x-rays were obtained, and respiratory support, as well as the ventilatory settings, were adjusted according to the blood gas estimates, which were obtained via umbilical and/or radial arterial catheters. Bowel decompression was achieved by nasogastric aspiration. All ventilated infants were paralyzed, and volume expanders as well as dopamine were used when indicated to maintain their blood pressure. Talozoline, surfactant, nitric oxide and dexamethasone were not used in any of our patients, and metabolic acidosis was corrected with bicarbonate therapy.All operations were performed by a transverse upper abdominal incision. After reducing the contents, primary closure of the diaphragmatic defect was performed and prosthetic graft was used whenever primary repair without tension could not be achieved. ResultsFrom 1982 to 1997, a total of 47 cases of congenital diaphragmatic hernia were admitted to our hospital. There were three cases of M...

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Bochdalek hernias in infants:Factors determining mortality

Cited by 58 publications

References 7 publications

Congenital Diaphragmatic Hernia: Update on Regional Experience

Congenital Diaphragmatic Hernia: Update on Regional Experience

Bochdalek Hernia in Adults: A Report of Two Cases with a Review of the Japanese Literature

Congenital Diaphragmatic Hernia: The Impact of Preoperative Stabilization on Outcome

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