Emergency surgery due to diaphragmatic hernia: case series and review

Abstract

BackgroundCongenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17–6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.MethodsFrom May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.ResultsCase 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.ConclusionOverlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.

Morgagni hernia: Report of two cases and brief review of anatomy and literature

“…[10] Computed Tomography is considered the gold standard for diagnosing and evaluating Morgagni hernias and other diaphragmatic defects. [4,11] Bowel and omentum can easily be seen on a non-contrast scan. [6] Endoscopy is generally not helpful in diagnosis.…”

“…[12] Mesh has been particularly advocated in cases of large defects or muscle weakness. [4,11] Morgagni hernias may be repaired via a thoracic or abdominal approach, but bowel obstruction mandates an abdominal approach. [1,13] Large right-sided defects are also frequently repaired with combined transthoracic and transabdominal approaches [13,14] The first laparoscopic repair of a Morgagni hernia was reported in 1992.…”

Orthopnea and fever in an elderly woman

“…16 In the elderly, diaphragmatic hernias due to congenital etiology are detected with a frequency of 0.17-6%, being most often associated with acquired causes such as thoraco-abdominal injuries. 17 Asymptomatic cases are usually missed on a first clinical evaluation, and manifest only with overt signs of complications. 17 Acute respiratory failure can be the result of severe lung compression from incarcerated bowel loops or stomach.…”

“…17 Asymptomatic cases are usually missed on a first clinical evaluation, and manifest only with overt signs of complications. 17 Acute respiratory failure can be the result of severe lung compression from incarcerated bowel loops or stomach. Patients present often with dyspnea.…”

“…18 Lung auscultation can reveal also the presence of bowel sounds in one or both chest areas, without any vesicular murmur on examination. 17 Blood gas analysis can reveal acute type II respiratory failure, but the use of noninvasive positive-pressure ventilation (NPPV) should be used with caution because it can further deteriorate the clinical picture by increasing abdominal pressure and diaphragmatic herniation. 19 Patients with CDH can present also with abdominal pain and vomiting secondary to bowel obstruction and volvulus.…”