1/13. Delayed diaphragmatic herniation masquerading as a complicated parapneumonic effusion.Injury to the diaphragm following blunt or penetrating thoracoabdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
2/13. pentalogy of cantrell.Omphalocele is often associated with various abnormalities. In two patients admitted with omphalocele, we additionally found defects both in the pars stenalis of diaphragm and in the diaphragmatic surface of the pericardium, sternal defect and tetralogy of fallot. These entities form the components of a syndrome, named pentalogy of cantrell. It is extremely in the spectrum of midline closure defects that display wide variations and its incidence is very low. Existing cardiac defect is the most important factor influencing morbidity and mortality. Herein we report two cases of pentalogy of cantrell with the review of the syndrome in the light of literature.- - - - - - - - - - ranking = 158.267759377keywords = pentalogy (Clic here for more details about this article) |
3/13. Chronic liver herniation through a right Bochdalek hernia with acute onset in adulthood.Congenital right diaphragmatic hernia of Bochdalek rarely occurs in adults and usually is asymptomatic. We report a right Bochdalek hernia with chronic liver herniation and intestinal malrotation in a 55-year old woman who presented with acute intestinal occlusion. The diagnosis required definitive confirmation by CT scan. With impending strangulation, emergency surgery through a thoracoabdominal approach resulted in an easy hernia repair and reduced the technical difficulties due to the intestinal malrotation.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
4/13. A case of a diaphragmatic rupture complicated with lacerations of stomach and spleen caused by a violent cough presenting with mediastinal shift.INTRODUCTION: Diapraghmatic rupture is a clinical case that is mostly seen following a blunt thoracoabdominal trauma or is rarely reported as spontaneously induced by various factors. CLINICAL PICTURE: A 28-year-old man presented as an emergency with shortness of breath and severe abdominal pain following a violent cough. His chest radiography and computed tomography demonstrated left diaphragmatic rupture, mediastinal shift and herniation of gastric fundus into the pleural cavity. TREATMENT: Left thoracotomy for the replacement of herniated gastric fundus and median laparotomy for the repair of serosal layer of gastric fundus and a diaphragmatic gap were performed. OUTCOME: He made an uneventful recovery. CONCLUSIONS: Diaphragmatic ruptures may be caused by violent coughing with serious life-threatening complications.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
5/13. Incarcerated transdiaphragmatic intercostal hernia preceded by Chilaiditi's syndrome.Transdiaphragmatic hernia most often develops after blunt or penetrating thoracoabdominal trauma. We report on the case of a 73-year-old man who underwent emergency ileocoecal resection for an incarcerated transdiaphragmatic intercostal hernia. The patient's history included both a lumbotomy for right nephrectomy and Chilaiditi's syndrome. The literature regarding both transdiaphragmatic intercostal herniation and Chilaiditi's syndrome is reviewed in relation to the presented case.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
6/13. Intrathoracic splenosis secondary to previous penetrating thoracoabdominal trauma diagnosed during delayed diaphragmatic hernia repair.Although intraperitoneal splenosis is a very common disease, intrathoracic splenosis is very rare. It is generally an asymptomatic disease that occurs after thoracoabdominal trauma, and is diagnosed as an intrathoracic mass that leads to unnecessary investigations to be differentiated from other benign or malignant lesions of the chest. We present a patient with an intrathoracic mass which was preoperatively diagnosed as a diaphragmatic hernia on chest X-ray and magnetic resonance imaging. We have intraoperatively recognized that many pieces of splenic tissue have been herniated through a diaphragmatic defect, and formed intrathoracic splenosis. We repaired the diaphragmatic hernia defect after excision of fragments of the spleen.- - - - - - - - - - ranking = 5keywords = thoracoabdominal (Clic here for more details about this article) |
7/13. Bochdaleck's hernia complicating pregnancy: case report.Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk's gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek's hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. postoperative period was uncomplicated. pregnancy was allowed to continue until 39 wk's gestation at which time elective cesarean delivery was performed. It is concluded that symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
8/13. Incidental finding of congenital thoracic malformations in adult population.OBJECTIVE: Evaluation of abnormal adult chest computed tomography (CT) scans. STUDY DESIGN: Retrospective series of 3 cases. SETTING: Two University-based hospitals. INTERVENTION: Three adult patients (age range 56 to 61) underwent chest CT scans. Two were trauma patients and one complained of chest pain with a negative cardiac workup. One CT scan revealed a lung mass that was highly suspicious for malignancy and the other two CT scans were suspicious for diaphragmatic hernia. Two patients underwent elective surgery and the third underwent emergent surgery. RESULTS: The CT scan of patient 1 was suspicious for malignancy; however, the pathology of the lung mass revealed only inflammation consistent with an intralobular bronchopulmonary sequestration. Patient 2 had a congenital Morgagni hernia with omentum and colon in the mediastinum, and patient 3 had a diaphragmatic defect combined with a bifid sternum and defective pericardium, fulfilling three criteria of pentalogy of cantrell. CONCLUSION: Thoracic congenital malformations may go unnoticed and unsuspected until adulthood. They should be kept in mind when reviewing unusual CT scans of the chest in adults. Their surgical management, however, is similar to their counterparts in infancy.- - - - - - - - - - ranking = 79.133879688502keywords = pentalogy (Clic here for more details about this article) |
9/13. Congenital diaphragmatic hernia as a cause of cardiorespiratory failure and visceral obstruction in late pregnancy.BACKGROUND: Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. CASE PRESENTATION: A woman at 23 week gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek's hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. postoperative period was uncomplicated. pregnancy was allowed to continue until 39 weeks' gestation at which time elective cesarean delivery was performed. CONCLUSION: Symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.- - - - - - - - - - ranking = 1keywords = thoracoabdominal (Clic here for more details about this article) |
10/13. A neonatal case of thoracoabdominal duplication associated with right congenital diaphragmatic hernia, absent inferior vena cava, and congenital portoazygous shunt: etiopathogenesis and surgical management.We report on a neonatal case of thoracoabdominal duplication associated with a split notochord syndrome and multiple anomalies. A newborn girl had severe dyspnea and was transferred to our neonatal care unit. At laparotomy, the entire small bowel was herniated into the posterior mediastinum through a defect in the right hemidiaphragm. The small bowel mesentery was firmly fixed to the mediastinum such that a large part of the small bowel could not be repositioned into the abdominal cavity. Imaging studies revealed an absent inferior vena cava with an azygous continuation. The superior mesenteric vein joined the splenic vein to form a portoazygous shunt that ran caudally through the mediastinum and drained into the azygous vein. The patient's intrahepatic portal vein was completely absent. To the best of our knowledge, this is the first reported case of a thoracoabdominal duplication associated with a portoazygous shunt. The etiopathogenesis and surgical management of this complicated case are discussed.- - - - - - - - - - ranking = 6keywords = thoracoabdominal (Clic here for more details about this article) |
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