Salim BİLİCİ, Ufuk ÇOBANOĞLU, Duygu MERGAN, Fuat SAYIR, Mehmet MELEK

Diaphragmatic herniation diagnosed at a late stage: An evaluation of eight cases

Amaç: Bu çalışmada, spesifik klinik özellikleri ve ilginç klinik ve radyolojik tabloları olan ve son evrede tanı konulduktan sonra ameliyat edilen diyafragmatik hernili hastalar analiz edildi. Çalışma planı: Ocak 2006 ve Ağustos 2010 tarihleri arasında son evrede tanı konan ve kliniğimizde ameliyat edilen üçü erişkin ve beşi çocuk toplam sekiz diyafragmatik hernili olgu (4 erkek, 4 bayan; ort. yaş 12.4±24 yaş; dağılım 9 ay-28 yıl) retrospektif olarak değerlendirildi. Tüm hastalarda laparotomi ve torakotomi sonrasında herni redüksiyonu ve primer onarımı yapıldı. Bulgular: Çocukların tanısı neonatal dönem sonrasında konuldu. Üç olguya erişkin dönemde tanı kondu. Beş hastada sağ taraflı doğuştan Morgagni hernisi; bir hastada hiatal herni ve iki hastada sol taraflı Bochdalek hernisi mevcuttu. Ameliyattan sonra 5 ila 19. günler arasında tüm hastalar taburcu edildi. Hastanede ortalama kalış süresi 9.8 gündü (dağılım 7-23 gün). Hastalar altı ay ila iki yıl süreyle takip edildi ve anlamlı bir solunum veya gastrointestinal yakınma kaydedilmedi. Morgagni hernisi olan üç olguda da herhangi bir sorun tespit edilmedi. Sonuç: Doğuştan olan diyafram hernileri, çoğunlukla neonatal dönemde görülen patolojiler olup, sonrasında bu hernilerin tanısı güçleşebilir. Takip edilen ve deneyimli uzmanlar tarafından klinik olarak tedavi edilen olgularda mortalite ve morbidite oranları düşüktür.

Son evrede tanılanan diyafragmatik herniasyon: Sekiz olgu değerlendirmesi

Background: In this study, we aimed to analyze patients with diaphragmatic hernias who had specific clinical features and interesting clinical, radiologic presentations, and had operated following late diagnosis. Methods: A total of eight diaphragmatic hernia cases, of whom three were adults and five were children (4 males, 4 females; mean age 12.4±24 years; range 9 months to 28 years), who were diagnosed in the late period and who were operated on in our clinic between January 2006 and August 2010 were evaluated retrospectively. In all patients, primary repair of the diaphragm was performed following laparotomy and thoracotomy. Results: The children were diagnosed following the neonatal period. Three patients were diagnosed in adulthood. Five patients had right-sided congenital Morgagni hernias, one patient had a hiatal hernia, and two patients had left-sided Bochdalek hernia. All patients were discharged between the 5th a nd 1 9th postoperative days. The average duration of hospital stay was 9.8 days (range 7 to 23 days). The follow-up time were between six months and two years, and no significant respiratory and gastrointestinal complaints were recorded. No morbidity was detected in three cases with Morgagni hernia. Conclusion: Congenital diaphragmatic hernias are pathologies which are seen in the neonatal period, and the diagnosis of these hernias can be difficult after this period. Mortality and morbidity rates are low in cases who are followed and treated in clinics by dedicated thoracic surgeon.

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