López CG, Bravo TM, López DAV, López-Días PS, Reyes GU, Pacheco BCF, Reyes HKL, Rodríguez MM, Rodríguez GJ, Quero HA, Miranda GD, Balderas CX

Language: Spanish
References: 22
Page: 33-38
PDF size: 316.48 Kb.

ABSTRACT

Right diaphragmatic hernia allows the passage of abdominal contents into the thoracic cavity, causing disturbances in pulmonary development. It is relatively rare. And there is a lack of clinical data. This case presents a female newborn, born preterm at 36 weeks of gestation, with an appropriate weight for gestational age. Likewise, right diaphragmatic hernia, primary pulmonary hypertension, patent foramen ovale, and late neonatal sepsis were observed. Chest X-ray was inconclusive for right diaphragmatic hernia. Contrast tomography shows: right posterolateral diaphragmatic hernia. The left hemithorax shows pneumonic process in the left lower lobes. Right posterior thoracotomy is performed. Findings: hernial sac, without intestinal loops inside, with peritoneal fluid. Diaphragmatic plasty was performed with silk 2/00. Without incidents. The postoperative evolution shows normal mobility of the right hemidiaphragm, and paralysis of the surgical site, ascending to level 6.7 of the costal arches, not worthy of surgery. The diagnosis of right Bochdalek hernia is difficult. Diagnostic problems include: late radiographic manifestations and the induction of the inflamatory disease of the thorax. As the survival of patients with congenital diaphragmatic hernia improves, long-term care should be continually studied and adjusted. To ensure adequate surveillance and optimization of long-term outcomes.

REFERENCES

1. Mantilla JC, Melo MA, Vargas LM. Hernia diafragmáticacongénita derecha en el Hospital Universitariode Santander. Rev Univ Ind Santander Salud. 2010; 42( 2 ): 133-8.

2. Jeong J, Lee BS, Cha T, Jung E, Kim EA, Kim KS,et al. Prenatal prognostic factors for isolated rightcongenital diaphragmatic hernia: a single center’sexperience. BMC Pediatr. 2021; 21(1): 460.

3. Iqbal CW, Derderian SC, Lusk L, Basta A, Filly RA,Lee H, et al. Outcomes for Prenatally DiagnosedRight Congenital Diaphragmatic Hernia. FetalDiagn Ther. 2020; 47(1): 1-6.

4. García-Posada R, Gómez O, Martínez JM, PuertoB, Gratacós E. Hernia diafragmática congénita: criteriospronósticos y estado actual del tratamientoprenatal. Guía clínica. Diagn Prenat. 2012; 23(3):126-33.

5. Aihole JS. Congenital right diaphragmatic defects:Our institutional experience. Afr J Paediatr Surg.2021; 18(3): 133-8.

6. Okamoto M, Amano H, Uchida H, Hinoki A, TainakaT, Shirota C, et al. Clinical characteristics and outcomesof the right congenital diaphragmatic herniacompared to the left: a 10-year single-center experience.Pediatr Surg Int. 2021; 37(12): 1675-81.

7. Robertson DJ, Harmon CM, Goldberg S. Right congenitaldiaphragmatic hernia associated with fusionof the liver and the lung. J Pediatr Surg. 2006;41(6): e9-10.

8. Taide DV, Bendre PS, Kirtane JM, Mukunda R. Hepaticpulmonary fusion: a rare case. Afr J PaediatrSurg. 2010 Jan-Apr; 7(1): 28-9.

9. Gasmi M, Mekki M, Jouini R, Belghith M, Nouri A.Découverte inhabituelle d’une fusion hépato-pulmonairelors d’une cure d’une hernie diaphragmatiquecongénitale droite [Unusual discovery ofhepato-pulmonary fusion during right congenitaldiaphragmatic hernia surgery]. Presse Med. 2003;32(10): 460-1.

10. Gander JW, Kadenhe CA, Fisher JC, Lampl BS, BerdonWE, Stolar CJ, et al. Hepatic pulmonary fusionin an infant with a right-sided congenital diaphragmatichernia and contralateral mediastinal shift. JPediatr Surg. 2010; 45(1): 265-8.

11. Patel S, Rael J. Right-Sided Congenital DiaphragmaticHernia Caused by Hepatopulmonary Fusion.Case Rep Pediatr. 2020; 29: 8851341.

12. Almaramhy HH. Hepatopulmonary fusion associatedwith right-sided congenital diaphragmatichernia: management of this rare anomaly and a reviewof the literature. J Int Med Res. 2018; 46(12):5278-84.

13. Akinkuotu AC, Cruz SM, Cass DL, Cassady CI, Mehollin-Ray AR, Williams JL, et al. Revisiting outcomesof right congenital diaphragmatic hernia. JSurg Res. 2015; 198(2): 413-7.

14. Kirchner SG, Burko H, O’Neill JA, Stahlman M. Delayedradiographic presentation of congenital rightdiaphragmatic hernia. Radiology. 1975; 115(1): 155-6.

15. Jain V, Yadav DK, Kandasamy D, Gupta DK. Hepatopulmonaryfusion: a rare and potentially lethalassociation with right congenital diaphragmatichernia. BMJ Case Rep. 2017; 14: bcr2016218227.

16. Hamilton J, Jaroszewski D, Notrica D. Fatal complicationafter repair of a congenital diaphragmatichernia associated with hepatopulmonary fusion,anomalous right pulmonary venous return, andazygos continuation of the inferior vena cava. EurJ Pediatr Surg. 2014; 24(4): 350-2.

17. Ishimoto K, Hayashida M, Ueda M, Okamura K, LeiriS. High insertion of the right diaphragm complicatedwith congenital diaphragmatic hernia: A casereport of rare thoracoscopic findings. Asian J EndoscSurg. 2022; 15(4): 854-8.

18. Karmazyn B, Shold AJ, Delaney LR, Brown BP, MarineMB, Jennings SG, et al. Ultrasound evaluation ofright diaphragmatic eventration and hernia. PediatrRadiol. 2019; 49(8): 1010-7.

19. Abramov A, Fan W, Hernan R, Zenilman AL, WynnJ, Aspelund G, et al. Comparative outcomes of rightversus left congenital diaphragmatic hernia: A multicenteranalysis. J Pediatr Surg. 2020; 55(1): 33-8.

20. Duan M, James TEH, Chandran S. Right-sided congenitaldiaphragmatic hernia masqueraded as rightlobar pneumonia in a term newborn infant. BMJCase Rep. 2021; 14(11): e244975.

21. Gerall CD, Stewart LA, Price J, Kabagambe S, SferraSR, Schmaedick MJ, et al. Long-term outcomesof congenital diaphragmatic hernia: A single institutionexperience. J Pediatr Surg. 2022; 57(4): 563-9.

22. Yamoto M, Nagata K, Terui K, Hayakawa M, OkuyamaH, Amari S, et al. Long-Term Outcomes ofCongenital Diaphragmatic Hernia: Report of a MulticenterStudy in Japan. Children (Basel). 2022;9(6): 856.