Iatrogenic Anterior Diaphragmatic Hernia in Childhood

Abstract

Congenital anterior diaphragmatic hernias (ADH) account for 2 - 6 % of diaphragmatic defects, whereas acquired ADH are rare. These hernias are most often the result of blunt or penetrating trauma. This is the first report of iatrogenic ADH in childhood. Two children with asymptomatic, iatrogenic ADH were diagnosed at 6 and 12 months of age, respectively. Both had undergone previous cardiac surgery requiring pericardial drainage. The ADH was seen on an incidental chest X-ray in one patient, and during a laparoscopic-assisted gastrostomy in the other. Both were successfully repaired laparoscopically. Subxiphoid pericardial drains may result in iatrogenic ADH. A high index of suspicion after cardiac surgery is necessary to avoid missing this potentially serious complication. Laparoscopy is a useful tool in both the diagnosis and repair of this condition.

Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

“…The majority of the handful of iatrogenic diaphgramatic hernias reported in the literature are in adults, with only one previously reported case report in the pediatric population [2]. Bettolli et al [2] reported two cases of incarcerated bowel following peri-cardial drain placements.…”

“…Bettolli et al [2] reported two cases of incarcerated bowel following peri-cardial drain placements. Here we report a case of iatrogenic diaphragmatic hernia resulting in strangulated bowel.…”

“…Acquired or iatrogenic diaphragmatic hernias on the other hand are probably under reported in the pediatric population, with only a single case report describing two uneventful cases after pericardial drainage following cardiac surgery [2]. Here we report a case of an incidental finding of an acquired diaphragmatic hernia resulting in strangulated small bowel following a traumatic chest tube that was inserted six months prior to presentation.…”

Laparoscopic repair of iatrogenic anterior diaphragmatic hernia

“…Very rarely acquired ADH can be iatrogenic. There are only three cases of acquired ADH reported in the pediatric age group (Bettolli et al, 2008;Dutta and Albanese, 2007). All the three cases were seen following cardiac surgery.…”

“…Acquired anterior diaphragmatic hernias on the other hand are very rare and usually seen following blunt or penetrating trauma. Iatrogenic anterior diaphragmatic hernia is extremely rare and only three cases were reported in children (Bettolli et al, 2008;Dutta and Albanese, 2007). This report describes the fourth iatrogenic anterior diaphragmatic hernia in a child that was repaired laparoscopically.…”