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Case Reports
. 2019 Sep;40(9):949-953.
doi: 10.15537/smj.2019.9.24378.

Surgical repair of bilateral congenital diaphragmatic hernia associated with hepatopulmonary fusion

Osama A Bawazir  1
Affiliations
Case Reports

Surgical repair of bilateral congenital diaphragmatic hernia associated with hepatopulmonary fusion

Osama A Bawazir. Saudi Med J. 2019 Sep.

Abstract

Bilateral congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with high neonatal mortality. The condition is rarely associated with hepatopulmonary fusion (HPF). We reported the surgical repair of bilateral CDH in a male infant aged 6 weeks. The patient had herniation of the liver on the right side with HPF in association with anomalous drainage of the right pulmonary vein into the hepatic vein and ventricular septal defect. We approached both sides thoracoscopically; however, the right side required a subcostal incision. We separated the liver from the right lower lung lobe laterally using electrocautery, and the defect was closed with a mesh. The medial portion was left intact to avoid injury of the anomalous pulmonary venous drainage. After 2 weeks, the patients had a surgical repair of the cardiac defects, and the postoperative course was complicated by bleeding and prolonged ventilation. No hernia recurrence was observed after 9 months.

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Figures

Figure 1
Figure 1
Preoperative chest x-ray showing liver herniation on the right side (arrow) and suspected stomach herniation behind the cardiac shadow on the left side.
Figure 2
Figure 2
Chest CT scan (coronal view) showing bilateral diaphragmatic hernia (arrows).
Figure 3
Figure 3
Preoperative angiography showing A) the anomalous pulmonary venous connection of the right lower lobe and B) blood supply of the right lower lobe from the abdominal aorta.
Figure 4
Figure 4
Thoracoscopic view of the A) left thoracic cavity after reduction of the contents and B) the diaphragm is repaired by direct sutures (arrow).
Figure 5
Figure 5
Thoracoscopic view of the right thoracic cavity showing A) the fusion between the right lower lung lobe and the liver (white arrow)and the B) diaphragmatic defect and the hernia sac (black arrow).
Figure 6
Figure 6
Postoperative chest x-ray showing full lung expansion and reduction of the hernia and bilateral chest tubes.
Figure 7
Figure 7
Case flow diagram of a newborn patient with bilateral congenital diaphragmatic hernia.
See this image and copyright information in PMC

References

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