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Posterolateral Diaphragmatic Hernia - the Hyderabad experience

Parkash Mandhan, Abdul Sattar Memon..

Abstract
OBJECTIVES: To see the mode of presentation and treatment of posterolateral diaphragmatic hernia and the complications and mortality associated with it in our setting. DESIGN: A descriptive study conducted during October 1998 to April 2002 at Liaquat Medical University Hospital Hyderabad, Pakistan METHODS: A retrospective review of charts was done and 13 patients with posterolateral diaphragmatic hernias (bochdalek hernia) were identified. RESULTS: There were 11 girls and 2 boys. The average age of presentation was 23 hours and the referral was late in the home-delivered babies as compared to the hospital-delivered neonates. The common referring diagnosis was pneumonia, respiratory distress and congenital heart lesions. Eight neonates had symptoms 12 hours after the birth and five reported after first 24 hours of their life. Ten children had associated anomalies, of which six had multiple and four of them died without any surgical intervention. Nine children were operated after preoperative stabilization via the abdominal approach. In 89%, a direct closure of defect was done and in five, ventral hernia was created to accommodate the herniated abdominal viscera. Sac was identified in four cases and excised before closure of defect. Chest drain was put in five patients. Six children had various complications, which include pneumothorax, chest and wound infections. The seven children survived and the overall mortality was 46%. CONCLUSION: Although, the results in the present set of available facilities are comparable with other local series, but an early diagnosis by providing education about such conditions at primary level, better pre and post-operative support and the facilities of neonatal intensive care unit will significantly help in the reduction of morbidity and mortality among these children.

Key words: Diaphragmatic Hernia. Hernia, Diaphragmatic, Traumatic. Vision, Ocular. Abnormalities, Multiple. Chromosome Disorders. Melena. Learning. Intestinal Obstruction. Laparotomy.



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