Primary paraesophageal hernia in children
| Autor: | Jonathan Karpelowsky, Nicky Wieselthaler, Heinz Rode |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Paraesophageal Diaphragm Fundoplication Asymptomatic medicine Humans Hernia Esophagus Child business.industry General surgery Infant Newborn Transverse colon Infant General Medicine medicine.disease Dysphagia digestive system diseases Surgery Radiography Bowel obstruction Hernia Hiatal medicine.anatomical_structure Pneumothorax Child Preschool Pediatrics Perinatology and Child Health Female medicine.symptom business |
| Zdroj: | Journal of Pediatric Surgery. 41:1588-1593 |
| ISSN: | 0022-3468 |
| Popis: | Background Paraesophageal hernias are uncommon in children and are distinctively different from the more common sliding hiatus hernias and those occurring after antireflux surgery in anatomy, pathology, symptoms, complications, and management. We reviewed a single institution's experience with the pathology of paraesophageal hernias. Methods We conducted a retrospective analysis of patient records. Results Fifty-nine children with paraesophageal hernias were treated during a 42-year period. Their mean age at presentation was 23.4 months (range, 1 day to 11 years). Presenting complaints were recurrent chest infections (n = 32), vomiting (n = 24), symptomatic anemia (n = 20), failure to thrive (n = 18), and dysphagia (n = 6). Five children were asymptomatic, and their diagnosis was established when they were investigated for incidentally noted asymptomatic anemia (n = 3), scoliosis (n = 2), and mumps (n = 1). Radiology typically showed cystic masses in the posterior mediastinum in the right lower chest and occasionally had an air-fluid level in the cystic mass or a dilated esophagus. None presented with strangulation or hematemesis. All patients were operated on. Surgical findings included a peritoneal lined sac and herniation through a widened diaphragmatic hiatus, containing the stomach and at times the transverse colon, spleen, and small bowel. The hernial sac usually occurred on the right. Principles of surgery included reduction of the contents, partial excision of the sac, crural approximation, and a fundoplication in 39 patients. No fundoplication was done in the earlier years in 20 patients, of whom 12 had recurrent reflux symptoms. Postoperative complications were bowel obstruction (n = 6), intussusception (n = 3), dysphagia (n = 3), breakdown of the repair (n = 3), and pneumothorax (n = 1). There was one mortality caused by preoperative aspiration. Conclusion Paraesophageal hernias in children are uncommon and most likely caused by a congenital defect. They are associated with considerable morbidity. Strangulation is not a feature. Principles of repair are well established and should include an antireflux procedure. |
| Databáze: | OpenAIRE |
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