Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation

Abstract

Background Acquired diaphragmatic hernia (DH) following liver transplantation (LT) is usually considered a surgical emergency. Interplay of contributing elements determines its occurrence but, in children, LT with partial liver grafts seems to be the most important causative factor. Methods This retrospective study describes the clinical scenario and outcomes of 11 patients with acquired DH following LDLT. Results During the study period, 1109 primary pediatric LDLT were performed (0.8% DH). The median age and BW of the recipients with DH at transplantation were 17 months and 11.1 kg, respectively; 63.7% of the cases had a weight/age Z‐score of less than −2 at transplantation. The median interval between transplantation and diagnosis of DH was 114 days (32–538 days). A total of 6 (54.5%) of the patients had bowel obstruction due to bowel migration into the hemithorax. Ten defects were right‐sided. Three patients required enterectomy and enterorrhaphy. Two patients required a new bilioenteric anastomosis, and one of them had complete necrosis of the Roux‐in‐Y limb. The patient with left‐side DH presented gastroesophageal perforation. Conclusion Most defects necessitate primary closure as the first treatment, and recurrence is rare. The associated problems encountered, especially related to intestinal complications, can determine increased morbidity following DH repair. Early diagnosis and intervention are required for achieving better outcomes.

A rare complication of pediatric liver transplantation: Post‐transplant diaphragmatic hernia

“…The median time to diagnosis of PTDH was 9 months, and six of seven patients were diagnosed in the postoperative first year in our series. Approximately 90% of patients who were reported in the literature were diagnosed in the first postoperative year 3–5,10 . Therefore, respiratory problems developing in the early to mid‐term postoperative period needs to be approached cautiously by the transplant surgeons and physicians, and PTDH should be considered in the differential diagnosis.…”

“…Consequently, the risk factors and causes of PTDH may differ from case to case. [3][4][5] In 2015, we reported our first PTDH case 6 and we had six more consecutive cases. The primary objective of this study was to analyze patients who have experienced diaphragmatic hernias following liver transplantation and to discuss the potential causes and management protocols for this complication.…”

“…Furthermore, PTDH may also present as an acute and life‐threatening condition necessitating prompt surgical intervention. Consequently, the risk factors and causes of PTDH may differ from case to case 3–5 …”

“…This process is relatively an early complication that probably occurs in the first few weeks following OLT as evidenced in our patient series in which the earliest diagnosis of PTDH was within 2 months in one (Figure2) and 6 months in two (Figure3) consecutive patients.The median time to diagnosis of PTDH was 9 months, and six of seven patients were diagnosed in the postoperative first year in our series. Approximately 90% of patients who were reported in the literature were diagnosed in the first postoperative year [3][4][5]10. Therefore, respiratory problems developing in the early to mid-term postoperative period needs to be approached cautiously by the transplant surgeons and physicians, and PTDH should be considered in the differential diagnosis.…”