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Large Congenital Paraesophageal Hernia and the Risk of Intrathoracic Gastric Volvulus - Abstract

Ahmed H. Al-Salem, Hilal Matta

 

Abstract

Aim: Congenital paraesophageal (CPH) is rare in infants and children. It can unusually be large with herniation of most of the stomach which can lead to intrathoracic gastric volvulus. This report describes our experience with infants and children with large CPH.

Patients and Methods: Twelve infants and children with large CPH, three of them presented with intrathoracic gastric volvulus were evaluated. Their medical records were reviewed for age at diagnosis, sex, clinical features, diagnosis and management. Results: Between 1992 and 2012, twelve infants and children with large CPH were treated. There were 7 males and 5 females. Their age at diagnosis ranged from 2 days to 2.5 years (mean 16.3 months). Two presented acutely, immediately after birth with respiratory distress secondary to a large CPH. One of them had intrathoracic gastric volvulus. Four presented with recurrent chest infection and failure to thrive while the remaining three had repeated attacks of vomiting. Another patient was a case of repaired esophageal atresia and tracheoesophageal fistula. He presented at the age of 2.5 years with recurrent attacks of cough and vomiting for one-year duration and was found to have a large paraesophageal hernia. Two patients were sisters and both of them presented with recurrent chest infection and failure to thrive. At the time of presentation, both had large CPH with intrathoracic gastric volvulus.

Conclusions: CPH is rare in the pediatric age group and sometimes it is unusually large with herniation of most of the stomach which may result in intrathoracic gastric volvulus. Awareness of this and early diagnosis and treatment are important to avoid subsequent morbidity and mortality.

Keywords: paraesophageal hernia, infants and children, familial, fundoplication

doi: 10.21614/jpss.11.1.6

Citation: J Pediatr Surg Spec. 2017;11(1):6-10

 

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