Reported here is the case of a 6 year old male child with a left Congenital Diaphragmatic Hernia who underwent thoracoscopic repair. The use of continuous low pressure CO2 insufflation pneumothorax during the procedure not only made manipulation during the reduction of bowel contents back into the abdomen easier, but also facilitated repair of the defect as it maintained bowel reduction during suturing. Although prolonged CO2 has been hypothesized to be hazardous leading to hypercapnea and aggravating pulmonary hypertension in Congenital Diaphragmatic Hernia patients. The authors found it to be a safe modification of the technique as long as pre-operative planning, patient selection and intra-operative maneuvers were proprely performed.
Hernias, Diaphragmatic, Congenital

This is a case report of a sliding hiatal hernia with severe gastroesophageal reflux (GER) after repair of congenital diaphragmatic hernia(CDH). It was not possible to determine whether the hiatal hernia is a de novo lesion which was missed at the original operation or a consequence of overzealous repair of the Bochdalek defect at the expense of weakening of the diaphragmatic crura. This case demonstrates that a sliding hiatal hernia can be a cause of severe gastroesophageal reflux that should be managed surgically.
Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal ; Hernias, Diaphragmatic, Congenital ; Herniorrhaphy

Hernias, Diaphragmatic, Congenital/surgery* ; Humans ; Liver/diagnostic imaging*

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein* ; Catheters* ; Extracorporeal Membrane Oxygenation* ; Heart ; Hernias, Diaphragmatic, Congenital* ; Humans ; Infant, Newborn* ; Oxygen ; Radiography, Thoracic

The authors have experienced two cases of general anesthesia for repair of congenital diaphragmatic hernia. Both patients were female (1 year 5 months and 8 months of age) and had left sided Bochdalek hernia. Anesthesia was maintained with halothane-oxygen using nonrebreathing system with Ruben valve, and the patients tolerated the whole procedure very well. The importance of maintaining adequate ventilation with high concentrations of oxygen and avoiding abdominal distension has been stressed.
Anesthesia ; Anesthesia, General ; Female ; Hernia ; Hernias, Diaphragmatic, Congenital* ; Humans ; Oxygen ; Ventilation

Persistent pulmonary hypertension of the newborn (PPHN) secondary to congenital diaphragmatic hernia (CDH) is one of the main reasons for high mortality of the newborn and a factor that leads to respiratory and circulatory failure in newborns with CDH. PPHN secondary to CDH is severe and difficult to treat, with poor prognosis. Therefore, prenatal intervention aims for preventing the pathological process of CDH, especially the etiological treatment for impeding the development of PPHN, has become a research focus. Given unknown causes and poor outcomes of PPHN, this article summarizes the research advances in pathogenesis and treatment of PPHN secondary to CDH based on related studies so as to provide a reference for relevant studies and clinical treatment.
Hernias, Diaphragmatic, Congenital ; complications ; Humans ; Infant, Newborn ; Persistent Fetal Circulation Syndrome ; etiology ; therapy

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein ; Catheters ; Extracorporeal Membrane Oxygenation ; Heart ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Oxygen ; Radiography, Thoracic

Child, Preschool ; Cleft Lip ; complications ; surgery ; Cleft Palate ; complications ; surgery ; Hernia, Diaphragmatic ; complications ; surgery ; Hernias, Diaphragmatic, Congenital ; Humans ; Male

Adult ; Female ; Fetal Organ Maturity ; Hernia, Diaphragmatic ; complications ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Lung ; pathology ; Myocardium ; pathology ; Pregnancy

OBJECTIVETo access the expression of transforming growth factor beta1 (TGF-beta1) in the lung of Nitrofen-induced congenital diaphragmatic hernia rat model.

METHODSTwelve timed-pregnant Sprague-Dawley rats were randomly divided into two groups, namely control group and CDH group on day 9.5 of gestation. Each rat in the CDH group was given 125 mg of Nitrofen (dissolved in seed fat) by gavage. Each rat in the control group was given the same dose of single oil. On day 16 of gestation, the two groups mentioned above were divided into three subgroups, and fetuses were delivered by cesarean section respectively on day 16, 18 and 21 of gestation. After the fetuses were checked for diaphragmatic hernia, lung tissue weight (LW) and body weight (BW) of each fetus on gestational day 21 were recorded. Lung histologic evaluations were made with microscope and TGF-beta1 immunohistochemistry staining were performed with image analyzing.

RESULTSAt day 16 of gestation, no visible diaphragm closure was observed in all fetuses. Diaphragmatic hernia was observed in 32 of the 44 rat fetuses of the CDH groups on day 18 and day 21 of gestation (72.7%). Lw/Bw of the 21d subgroups of CDH group were lower than those of corresponding control group (P < 0.01). Observed under the microscope, the lungs of fetuses in CDH groups showed marked hypoplasia. The expression of TGF-beta1 was detected in cytoplasmic, without definite expression in nuclear. It was significantly stronger that the expression of TGF-beta1 was in the lungs of the CDH group than that of the control group (P < 0.01).

CONCLUSIONSNitrofen interferes with lung development in early stage of the fetal before the diaphragm developed. TGF-beta1 would be one of the important factors which lead to pulmonary hypoplasia.

Animals ; Disease Models, Animal ; Female ; Hernia, Diaphragmatic ; metabolism ; Hernias, Diaphragmatic, Congenital ; Lung ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; metabolism