Dr. Obay abdul aziz Specialist pediatric surgeon
Associated anomalies (55% of the cases) VACTERL association cardiac . pulmonary. Ano-intestional. Genitourinary. Limb & Vertebral. chromosomol (Down syndrome ).1-prenatal diagnosisUltrasonography Maternal Polyhydramnios (60-90%) Blind – ending proximal esopegeal pouch MRI can confirm the diagnosis2-postnatal diagnosis Chest x-ray.Contrast study (water soluble)Bronchoscopy in H-type fistula
Management Preoperative resuscitation. Operative management. Thoracotomy (RT sided) Thoracoscopy Post operative follow up.
1. Bockdalek hernia (90%) 2. Morgagni hernia (2%) 3. Hiatal hernia (sliding, rolling) 4. Eventration of diaphragm
Incidence: 1/2000-5000 live birth. This is the commonest and the most serios type. It is more common on the left side (90%) & it present itself in two ways. Very early presentation (immediately after birth). Late presentation after several months or years.
The new born baby presented with severe respirator distress & Cyanosis. On examination: Tachypnea and cyanosis. Scaphoid abdomen. Increase chest diameter. On auscultation of the chest: bowel sound + Apex beat of the heart displaced to the right side (dextrocardia).
Diagnosis: 1.Chest x-ray :Presence of bowel shadow in the chest with compression of the lung of the same side (hypoplastic lung). Displaced mediastinum to the opposite side.Compression of the contra lateral lung.2.Barium study :
Peroperative stabilization:Oxygen therapy.Antibiotics.Iv-line.ECMOOperative repair of the diaphragm Thoracic Abdominal Post operative care and follow up.