Ultrasound Diagnosis of Congenital Diaphragm Hernia And Successful Outcome After Postnatal Surgery

Yusrawati yusrawati; Putri Mentari Faisal

doi:10.25077/jom.8.1.96-108.2023

Ultrasound Diagnosis of Congenital Diaphragm Hernia And Successful Outcome After Postnatal Surgery

DOI: http://dx.doi.org/10.25077/jom.8.1.96-108.2023

Author(s)

Yusrawati yusrawati (Section Obstetrics and Gynecology Faculty of Medicine Andalas University, Padang)
Putri Mentari Faisal (Specialist Doctor Education Program (PPDS) in Obstetrics and Gynecology, Faculty of Medicine, Andalas University)

Abstract

Background: Congenital diaphragmatic hernia (CDH) is a disorder where abdominal contents protrude into the chest. Congenital diaphragmatic hernias are seen in 1 of every 2000-4000 live births. Mortality is predominantly due to the development of pulmonary hypoplasia which is thought to be due to the mass effect on the developing lung.

Case Report:Mrs. Y, a 32-year-old controlled for antenatal care at the fetomaternal polyclinic M Djamil hospital. She had no complaints, the patient was referred from another hospital with a suspected fetal diaphragm hernia. The patient is known to be 38-39 weeks term pregnancy, from ultrasound examination found herniation of abdominal contents into the thoracic cavity and. the liquor was excessive and the doppler study was normal. The ultrasound showed normal growth and corresponded to 38 week Then the patient was planned for caesarean section and a hernia repair surgery. The neonate was admitted to the neonatal intensive care unit (NICU). He was shifted to the pediatric surgeon with ventilator support after 48 h and was undergoing surgery. There was a posterolateral left sided defect (BOCKDALEK type) of around 22–24 mm. The intestines were reduced to the abdomen and the closure was done. Immediately after the surgery, the child was admitted back to the NICU and the further postnatal course was uneventful.

Discussion and Conclusion: CDH is a malformation of the diaphragm due to failure of closure of the pleuroperitoneal canal at around 10 weeks leading to herniation of abdominal contents into the thoracic cavity leading to compression of lung tissues at pseudo glandular stage. CDH is often ultrasound diagnosed before birth [120, 121]. The intestine and/or the liver may be in the thorax and the lungs are small. US scan allows detailed assessment of the heart. The survival depends on the contralateral lung volume, Ninety percent of cases are due to posterolateral defect which is also called Bochdalek hernia—80% are left sided, 15% are right sided and 5% are bilateral. Herniated viscera leads to pulmonary hypoplasia and pulmonary hypertension. Prognosis depends on the gestational age at diagnosis (earlier the diagnosis, likely larger the defect), associated anomalies, contralateral lung volume, pulmonary vasculature (Doppler), cardiac function, liver herniation and gestational age at delivery

Keywords

Congenital diaphragmatic hernia, prenatal diagnosis, prenatal ultrasound diagnosis

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References

McGivern MR, Best KE, Rankin J, Wellesley D, Greenlees R, Addor MC, et al. Epidemiology of congenital diaphragmatic hernia in Europe: A register-based study. Arch DisChild Fetal Neonatal Ed. 2015;100(2):F137–44.

Deprest J, Brady P, Nicolaides K, Benachi A, Berg C, Vermeesch J, et al. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Semin Fetal Neonatal Med [Internet]. 2014;19(6):338–48. Available from: http://dx.doi.org/10.1016/j.siny.2014.09.006

Withem K. Sonographic Evaluation of a Fetal Right-Sided Diaphragmatic Hernia: A Case Study. J Diagnostic Med Sonogr. 2019;35(6):505–9.

Azwan RJ, Basyir V, Yusrawati Y. Antenatal Ultrasound Should Be For All; Congenital Diaphragmatic Hernia - A Case Report. J Midwifery. 2021;6(2):69.

Sperling JD, Sparks TN, Berger VK, Farrell JA, Gosnell K, Keller RL, et al. Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes? Am J Perinatol. 2018;35(10):919–924.

Chatterjee D, Ing RJ, Gien J. Update on congenital diaphragmatic hernia. Anesth Analg. 2020;131(3):808–21.

Cannata G, Caporilli C, Grassi F, Perrone S, Esposito S. Management of congenital diaphragmatic hernia (Cdh): Role of molecular genetics. Int J Mol Sci. 2021;22(12).

Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S. Congenital diaphragmatic hernia: A review. Matern Heal Neonatol Perinatol. 2017;3(6):1–16.

Tovar J.A. Congenital Diaphragmatic Hernia. Orphanet J Rare Dis [Internet]. 2012;7(1):1. Available from: http://www.ojrd.com/content/7/1/1

Russo FM, Cordier AG, De Catte L, Saada J, Benachi A, Deprest J. Proposal for standardized prenatal ultrasound assessment of the fetus with congenital diaphragmatic hernia by the European reference network on rare inherited and congenital anomalies (ERNICA). Prenate Diagn. 2018;38(9):629–37.

Shah D, Vaghela PK, Patel S, Acharya P. Antenatal Diagnosis of Congenital Diaphragmatic Hernia and Successful Outcome After Postnatal Surgery. J Fetal Med. 2017;4(3):153–5.

Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg. 1996;31(1):148–52.

Mullassery D, Ba'Ath ME, Jesudason EC, Losty PD. Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: A systematic review and meta-analysis. Obstetric Gynecol Ultrasound. 2010;35(5):609–14.