Congenital diaphragmatic hernia: a 20 year experience

Abstract

The records of 253 children with congenital diaphragmatic hernia admitted to The Hospital for Sick Children, Great Ormond Street, between 1961 and 1980 were analysed. The overall mortality of 37 per cent is greater than that reported in the preceding 13 years from the same institution, and showed no improvement over the 20 years. While there was no significant increase in the number of admissions over the study period, the proportion of children who underwent surgery within the first 6 h of life steadily increased from 13 per cent in the first five years to 39 per cent in the last five years. The mortality of this group (65 per cent) did not improve over the study period and this would account for the lack of improvement in the overall survival figures. However, analysis of birth weights, onset and severity of signs and lung weights indicates that the increasing number of early admissions was due to speedier transfer rather than to referral of more severely affected children in the later years.

Adult Bochdalek hernia simulating left pleural effusion: a review and a case report

“…Cases of misinterpretation of X-rays of adult Bochdalek hernias with pneumatocele, lung cysts, pneumotorax, have been reported. 2,[4][5][6][7][8][9]11 The presented case raises some interest because of the incorrect interpretation of the changes observed in the left pleural cavity: two radiologists independently diagnosed this case as left pleural effusion. There have been several similar case reports in the literature of misdiagnosing adult patients with Bochdalek hernia as having pleural effusion.…”

“…Acute manifestation in childhood, as well as presence of associated severe anomalies explains why so few of Bochdalek hernias are diagnosed in adults. 1,4 One of the reasons for late manifestations and diagnosing of Bochdalek hernia in adults is the late occurrence of herniation of abdominal organs through the diaphragmatic defect. It is believed that in prolonged or extreme increase of intra-abdominal pressure (pregnancy, delivery, abdominal trauma), abdominal organs pass through the diaphragmatic defect into the thoracic cavity.…”

“…Most cases of Bochdalek hernias are diagnosed in the neonatal period with 5 to 20% occurring after the fi rst month till the end of the childhood. [1][2][3][4] In children, Bochdalek hernias most often present with acute respiratory failure. 1 The condition is rarely seen in adults and in contrast to children is usually manifested with atypical chronic abdominal and respiratory symptoms: abdominal pain, loss of appetite, chest pain, cough, and dyspnea.…”

“…In some adults the hernia is even asymptomatic and is detected as an incidental fi nding in an image study which is the reason why the exact prevalence of adult Bochdalek hernia is impossible to determine. [1][2][3][4][5] There have been overall fewer than 200 cases of this congenial disorder described in the relevant literature. 5 The aim of the present case report was to present a rare case of Bochdalek hernia in an adult patient which imitates clinically left pleural effusion.…”

Congenital Hernia of Morgagni in Children

“…This is surprisingly high when compared to other series. 1,6,8,9 The reason for this is not known. An increased awareness among pediatricians and general practitioners is a contributing factor, as the mode of presentation in these patients is variable and nonspecific.…”