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. 2022 May;26(3):e14203.
doi: 10.1111/petr.14203. Epub 2021 Dec 8.

Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation

João Seda Neto  1   2   3 , Carolina M Costa  1   2   3 , Eduardo A Fonseca  1   2   3 , Rodrigo Vincenzi  1   2   3 , Renata Pugliese  1   2   3 , João Ivo X Rocha  1   2   3 , Karina Roda  1   2   3 , Marcel R Benavidez  1   2   3 , Caio Márcio V Oliveira  1   2   3 , Fabio Payão Pereira  4 , André Moreira Assis  5 , Flavia H Feier  1 , Paulo Chapchap  1   3
Affiliations

Intestinal complications are common in patients with acquired diaphragmatic hernia after pediatric living donor liver transplantation

João Seda Neto et al. Pediatr Transplant. 2022 May.

Abstract

Background: Acquired diaphragmatic hernia (DH) following liver transplantation (LT) is usually considered a surgical emergency. Interplay of contributing elements determines its occurrence but, in children, LT with partial liver grafts seems to be the most important causative factor.

Methods: This retrospective study describes the clinical scenario and outcomes of 11 patients with acquired DH following LDLT.

Results: During the study period, 1109 primary pediatric LDLT were performed (0.8% DH). The median age and BW of the recipients with DH at transplantation were 17 months and 11.1 kg, respectively; 63.7% of the cases had a weight/age Z-score of less than -2 at transplantation. The median interval between transplantation and diagnosis of DH was 114 days (32-538 days). A total of 6 (54.5%) of the patients had bowel obstruction due to bowel migration into the hemithorax. Ten defects were right-sided. Three patients required enterectomy and enterorrhaphy. Two patients required a new bilioenteric anastomosis, and one of them had complete necrosis of the Roux-in-Y limb. The patient with left-side DH presented gastroesophageal perforation.

Conclusion: Most defects necessitate primary closure as the first treatment, and recurrence is rare. The associated problems encountered, especially related to intestinal complications, can determine increased morbidity following DH repair. Early diagnosis and intervention are required for achieving better outcomes.

Keywords: children; diaphragmatic hernia; liver transplantation; living donation; outcomes.

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References

REFERENCES

    1. Kazimi M, Ibis C, Alper I, et al. Right-sided diaphragmatic hernia after orthotopic liver transplantation: report of two cases. Pediatr Transplant. 2010;14(5):e62-e64. doi:10.1111/j.1399-3046.2009.01168.x
    1. Shigeta T, Sakamoto S, Kanazawa H, et al. Diaphragmatic hernia in infants following living donor liver transplantation: report of three cases and a review of the literature. Pediatr Transplant. 2012;16(5):496-500. doi:10.1111/j.1399-3046.2012.01722.x
    1. Cortes M, Tapuria N, Khorsandi SE, et al. Diaphragmatic hernia after liver transplantation in children: case series and review of the literature. Liver Transpl. 2014;20(12):1429-1435. doi:10.1002/lt.23977
    1. Englert C, Helmke K, Richter A, et al. Diaphragmatic hernia resulting in enterothorax following pediatric liver transplantation: a rare complication. Transplantation. 2006;82(4):574-576. doi:10.1097/01.tp.0000231709.63721.5c
    1. Lee S, Seo JM, Younes AE, Oh CY, Lee SK. Thoracoscopic approach for repair of diaphragmatic hernia occurring after pediatric liver transplant. Medicine (Baltimore). 2015;94(33):e1376. doi:10.1097/MD.0000000000001376

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