The use of freeze-dry bovine pericardium (FDBP) in diaphragmatic herniorrhaphy in dogs.
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A study was conducted to investigate the effectiveness of freeze-dried bovine pericardium (FDBP) as a biomaterial in diaphragmatic herniorrhapy in dogs. Eight adult dogs were randomly selected and divided into two equal groups. In FDBP group, a diaphragmatic defect was induced and repaired with an identical size of FDBP. In the control group, a diaphragmatic wall was incised at three-side border creating a flap and sutured. Grossly, only mild intrathoracic adhesion was observed for most of the animals, and no herniation occured. Microscopically, the biomaterial incorporated into the host's tissue by ingrowth of young muscle fiber and massive new blood vessel formation in between the fibrous tissue.Keywords:
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Diaphragm (acoustics)
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Intrapericardial diaphragmatic hernia is characterised by a displacement of abdominal organs covered by a peritoneal diaphragm, into the pericardium. Eventration of the septum transversum can be defined morphologically but not clinically or roentgenologically. Basing on the development of the diaphragm, it would be possible to determine intrapericardial hernia as a very early inhibition malformation. - The article describes the successful outcome of treatment of a male infant, 9 months of age, who had an intrapericardial hernia.
Diaphragm (acoustics)
Ventral hernia
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A study was conducted to investigate the effectiveness of freeze-dried bovine pericardium (FDBP) as a biomaterial in diaphragmatic herniorrhapy in dogs. Eight adult dogs were randomly selected and divided into two equal groups. In FDBP group, a diaphragmatic defect was induced and repaired with an identical size of FDBP. In the control group, a diaphragmatic wall was incised at three-side border creating a flap and sutured. Grossly, only mild intrathoracic adhesion was observed for most of the animals, and no herniation occured. Microscopically, the biomaterial incorporated into the host's tissue by ingrowth of young muscle fiber and massive new blood vessel formation in between the fibrous tissue.
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Diaphragm (acoustics)
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Diaphragm (acoustics)
Chest tube
Thoracentesis
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In about 80-85% of CDH the hernia is on the left side, in 10-15% on the right side and in 5% bilaterally (Dott et al., 2003). Most diaphragmatic defects involve the posterior and lateral aspects of the diaphragm, such as the posterolateral or Bochdalek CDH (80-90%), often accompanied by herniation of the stomach, intestines, liver and spleen into the chest (Torfs et al., 1992). In cases of aplasia or agenesis of the diaphragm, CDH is summarized under the large Bochdalek defects (Baglaj et al., 1999). In about 5%, the defect is in other locations affecting e.g. the anterior retrosternal or parasternal diaphragm, referred to as the Morgagni-Larrey hernia. In these cases, there can be hernation of liver or intestines into the chest cavity. Other anterior hernias are associated with Cantrell’s Pentalogy including defects of the supraumbilical midline abdominal wall, the lower sternum, the diaphragmatic pericardium and there may be ectopia cordis. Central hernias affect the tendinous portion of the diaphragm.
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Pericardial-diaphragmatic rupture is a rare condition which occurs after blunt trauma and involves the herniation of abdominal organs into the pericardium. A 77-year-old female patient presenting with complaints of palpitation and difficulty in breathing was admitted to the emergency room. Left lateral thoracotomy revealed the herniation of abdominal organs into the thorax. A pericardial-diaphragmatic rupture and a pericardial rupture were found to co-exist. The diaphragm and the pericardium were repaired primarily. The case is presented here because herniation of abdominal organs into the pleural cavity through the pericardium is a rare condition. Przepuklina przeponowo-osierdziowa to rzadkie schorzenie występujące po tępych urazach, w którym dochodzi do przedostania się organów brzusznych do osierdzia. W pracy opisano przypadek 77-letniej pacjentki zgłaszającej palpitacje i trudności w oddychaniu, przyjętej na oddział ratunkowy. Lewa boczna torakotomia uwidoczniła przedostanie się narządów brzusznych do klatki piersiowej. Stwierdzono współwystępowanie przepukliny przeponowo-osierdziowej oraz przepukliny osierdziowej. Przeponę oraz osierdzie zaopatrzono pierwotnie. Przypadek ten zaprezentowano, ponieważ wpuklanie się narządów brzusznych do jamy opłucnej przez osierdzie jest rzadkim schorzeniem.
Diaphragmatic rupture
Thoracotomy
Pericardial cavity
Diaphragm (acoustics)
Thoracic cavity
Pericardial fluid
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Thirteen cases of diaphragmatic rupture following blunt trauma or gunshot wounds are presented. In 10 cases the diagnosis of diaphragmatic rupture was made immediately following the injury, and the defect was closed by primary diaphragmatic suture. In three cases, the diagnosis was delayed for 3 to 16 years after the initial trauma. In all of them, abdominal organs such as the colon or liver had migrated into the thoracic cavity. One of them had acute intestinal obstruction and died following several unsuccessful operations. The remaining two patients required plastic repair of the diaphragmatic hernia by a Dacron patch, and both recovered. The clinical and pathological aspects of diaphragmatic rupture, the importance of early diagnosis and surgical correction, and the surgical approach to this entity are considered. The use of Dacron fabric in delayed closure of diaphragmatic defects is described.
Diaphragmatic rupture
Diaphragm (acoustics)
Thoracic cavity
Blunt trauma
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We present our experience with the thoracoscopic treatment of congenital diaphragmatic eventration (CDE) in children through 15 years to evaluate the efficiency of the procedure and the potential risk of recurrence. Materials andWe reviewed the medical files of patients treated for CDE through thoracoscopy from 2000 to 2011. Age at surgery, sex, side of the lesion, procedure's details, postoperative course, and complications were analyzed. Mean follow-up was 12 months.In this study, eight patients (five males and three females) aged from 6 months to 7 years underwent thoracoscopic plication for six right and two left eventrations; one conversion was necessary due to a too small operative field. Mean operative time was 60.5 minutes. A chest drainage was placed in six patients. We observed two recurrences from which the first one was treated thoracoscopically by endostapler resection/suturing and the other one by laparotomy. At follow-up, all patients were asymptomatic with a correct level of the diaphragm.Thoracoscopic plication is feasible and safe, and we consider this approach as the gold standard for the treatment of CDE. However, we still need to carefully consider the possibility of introducing certain modifications to reduce the potential risk of recurrence.
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Diaphragm (acoustics)
Gold standard (test)
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• Two patients had acute rupture of the diaphragm from blunt trauma. One was a 10½-month-old infant, the youngest yet reported with this condition to our knowledge. He required emergency repair because of increasing encroachment on respiratory function by the hernial contents during the early hours of observation. The second patient, a ten-year-old boy with an associated fractured femur, underwent successful repair of a diaphragmatic laceration that included the pericardium. In this case the approach via the abdomen, used to rule out associated intraperitoneal injuries, actually facilitated the repair, particularly that of the diaphragmatic pericardium. (Arch Surg111:1009-1011, 1976)
Diaphragm (acoustics)
Diaphragmatic rupture
Blunt trauma
Penetrating Trauma
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Abstract BACKGROUND Bilateral congenital diaphragmatic hernia is a rare form of diaphragmatic hernia. Independently, pericardial defects are an extremely rare phenomenon. In the case presented, we provide the first complete description of an infant with bilateral congenital diaphragmatic hernia with complete agenesis of the pericardium and inferior parietal pleura. CASE A male infant was born at 38 weeks of gestation with a prenatal diagnosis of left‐sided congenital diaphragmatic hernia. After 1 week of aggressive management, the patient was taken to the operating room for repair. Intraoperatively, the patient was found to have absence of the diaphragm bilaterally, no pleura inferiorly, and no pericardium. A biological mesh was used to construct a diaphragm. At 6 months of age, the patient is growing normally, requiring only supplemental oxygen without pressure support. CONCLUSIONS Embryologically, this anomaly represents complete lack of development of the pleurocardial folds, pleuroperitoneal folds, and transverse septum, which is previously unreported. Birth Defects Research (Part A), 2005. © 2005 Wiley‐Liss, Inc.
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Agenesis
Parietal Pleura
Thoracic cavity
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The importance of recognizing congenitally absent left pericardium in the setting of acquired cardiovascular disease was recently appreciated during a case of coronary artery bypass grafting. An associated defect in the left hemidiaphragm and an abnormal location of the left phrenic nerve were found. Careful dissection of the phrenic nerve from the surface of the heart and closure of the diaphragmatic defect were necessary to avoid injury to the former and prevent hernia through the latter structure. Absent left pericardium discovered during cardiac surgery requires attention to the location of the left phrenic nerve and recognition of associated defects in the diaphragm. Arch Surg. 1997;132:318-319
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