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Herniation from Anterolateral Diaphragmatic Defect and Its Accompanying Dextrocardia: A New Type of Diaphragmatic Hernia, Opposite of Bochdalek
Gül İlayda Sarar, Ayşenur Celayir
University of Health Sciences, Turkey. Istanbul Zeynep Kamil Maternity and Children Diseases Health Training and Research Center, Department of the Pediatric Surgery
Introduction: Anterolateral diaphragmatic hernia developing from a defect in the pars costalis part of the septum transversum has been reported very rarely. Here, it is aimed to draw attention to the association of anterolateral congenital diaphragmatic hernia(CDH) and dextrocardia by presenting three very rare cases.
Cases presentation: 1.Case-Male born at 38th-week to a-38-year-old mother with prenatal diagnosis of bilateral central CDH, 22p11 deletion and double-outlet right ventricle with dextrocardia. He was intubated at birth, underwent bilateral CDH repair on postnatal-day-3, but died on the 12th postoperative day due to severe pulmonary hypoplasia.
2.Case- A-male born to a-34-year-old mother at 37-week of gestation with suspected prenatal left CDH/Diaphragmatic Eventration had spontaneous recovery from initial respiratory distress. Echocardiography revealed dextrocardia, patent foramen ovale and patent ductus arteriosus. He was discharged on the 4th day. Two-mount-later, stomach and intestinal gases were seen in the left hemithorax on X-ray. The left anterolateral hernia was repaired.
3.Case-Female born at 39th-week to a 26-year-old mother with prenatal left CDH diagnosisn was intubated due to respiratory distress at birth. Echocardiogram revealed dextrocardia, patent foramen ovale and ductus arteriosus. Left anterolateral CDH was repaired on postnatal-day-5.
Suspicion of dextroposition/dextrocardia was confirmed as dextrocardia by postnatal-echocardiography. Preliminary diagnosis was Bochdalek hernia, but during the operation anterolateral diaphragmatic defect were determined along anterolateral costal margins from the sternum. The left lobe of the liver, stomach, spleen and small intestines were herniated into the thorax in a-sac. The hernia sacs were removed and primary repair was performed. The first-case died at 15-day-old, and the other-two had uneventful follow-ups for two years.
Conclusion: Mediastinal shift and dextroposition are expected conditions in CDH. It should be kept in mind that the presence of dextrocardia may indicate anterolateral CDH.