Hernia diafragmática congénita Congenital Diaphragmatic Hernia. Fanuel Ballén *, Maribel Arrieta**. Recibido: enero 28 de Enviado para modificaciones. Una hernia diafragmática es un defecto congénito, una anomalía que se produce cuando el feto se está Ilustración de una hernia diafragmática congénita. OBJETIVO: Comparar a sobrevida pós-natal de fetos com hérnia diafragmática congênita esquerda grave isolada, os quais foram submetidos à oclusão.
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The Congenital Diaphragmatic Hernia (CDH) is an anatomical structural defect, Download full-text PDF diafragmática congénita es multidisciplinario; se. La hernia diafragmática congénita es un defecto estructural anatómico que permite el paso de estructuras abdominales hacia el tórax, con una consecuente . La hernia diafragmática congénita de Bochdalek se manifiesta frecuentemente como un distrés respiratorio grave del recién nacido y constituye una urgencia.
Dissection view from abdomen of the mummy. A Diaphragmatic hernia indicated by arrows could be seen in the right side of diaphragm Dph. Liver Lv and Colon Co are running thorough the diaphragmatic defect. Ligamentum teres hepatis is marked by asterisk. B Left part of diaphragm Dph. View from below.
Moreover, in all of the previously reported CDH cases, the sole diagnostic tool was a simple autopsy. Therefore, CT would not enable differentiation of mummy CDH cases in which abdominal organs had in fact herniated through the diaphragmatic defect.
In this regard, the present study is meaningful to concerned researchers. The CT images and autopsy results showed right-sided CDH, which type is less prevalent than left-sided instances  , .
In fact, this is the first ever report of a CT-assisted diagnosis of a pre-modern historical case of CDH. In our current investigation, we noted that the liver can be a uniquely useful organ for diagnosis of right-sided CDH in mummies, as its S-shaped curved pattern and uniform radio-density on CT images are maintained, even in cases of herniation into the thoracic cavity Data S5. By using the mummified liver as a kind of landmark, we speculated that the herniated contents on our CT images had stretched through the diaphragmatic defect and protruded further into the thoracic cavity.
In some previously reported cases of modern living CDH patients, CT images showed that the ipsilateral lung became hypoplastic by displacement of the abdominal organs into the thoracic cavity, while the mediastinum was deviated to the contralateral side  , .
These CDH signs were clearly seen in the Andong mummy of the present study. Actually, the right lung was compressed by the herniation; and the heart was shifted more to the left side of the thoracic cavity. As in other adult CDH cases already reported, it was speculated that this individual might have experienced some difficulties such as shortness of breath, abdominal pain, chest pain, nausea, or vomiting during his lifetime  , .
Most cases of Bochdalek CDH occur in infants or neonates with life-threatening complications, adult cases being relative rarities and asymptomatic  ,  —  , .
Therefore, it may seem unusual that our middle-aged subject had passed the critical point for survival, with such a serious Bochdalek CDH.
Still, we also admit that thanks to the rapid development of the CT technique, Bochdalek CDH has been detected with increasing frequency in adult patients nowadays  ,  ,  ,  , .
Some adult cases clearly show how well the clinical signs of CDH can be masked as individuals grow into adulthood. One such example is a year-old female patient who complained of mild dyspnea. In this patient, clinicians found very few signs and symptoms suggestive of adult CDH. By CT diagnostics, however, a remarkable displacement of abdominal organs into the thoracic cavity could be detected.
Additionally, serious atelectasis was also found in her left lung, while most of the left thoracic cavity was filled by displaced abdominal organs. The herniation was so serious that the patient's heart was shifted to the right, further compressing the right lung. In fact, this case clearly shows that adult CDH can be very serious even if the patient complains only of mild clinical symptoms.
Actually, Korean mummy of this study, as in the case of that year-old female patient, exhibited a serious degree of CDH along with a mediastinal shift.
However, when we searched the intestines for evidence of complications such as perforation or strangulation of herniated organs the causes of most fatal emergences of adult CDH  , we found none. Still, LHR remains an inconsistent measure of survival. Outcomes of CDH are largely dependent on the severity of the defect and the appropriate timing of treatment.
A small percentage of cases go unrecognized into adulthood. The baby will usually be immediately placed on a ventilator.
Extracorporeal membrane oxygenation ECMO has been used as part of the treatment strategy at some hospitals. In essence, the ECMO circuit acts as the baby's lungs. Babies require extra blood volume and hefty doses of blood thinners in order to keep the circuit running without clot formation, which could be potentially fatal. Even though the baby is not using her lungs, an ocillating ventilator maybe still be used to keep some air in the lungs so that they do not fully collapse while not being used.
During ECMO the pulmonary artery has a chance to rest, as it were, thus hopefully reducing the presence of pulmonary hypertension, one of the biggest complication of CDH cases. CDH repair can be done while the baby is on ECMO, although blood thinners increase the risk of bleeding complications. Once the baby is taken off ECMO the carotid artery is sealed and can no longer be used.
When repairing the hernia an incision is made in the abdomen.