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Strangulated diaphragmatic hernia presenting at 7 weeks of life as intractable shock.

Ismail, Abdul Qader Tahir and Alake, Oluwaseyi and El-Shimy, Nagui (2013) Strangulated diaphragmatic hernia presenting at 7 weeks of life as intractable shock. BMJ case reports, 2013. ISSN 1757-790X.

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Official URL: http://casereports.bmj.com/content/2013/bcr-2013-2...

Abstract

A 7-week-old infant presented to hospital pale and floppy, with 5 s capillary refill time. Blood gas showed severe acidosis (pH 6.86, partial pressure of carbondioxide 10.55 kPa, base excess 21.1). Hypotension persisted despite several fluid boluses so she was intubated and started on inotropic support. A chest X-ray revealed a congenital diaphragmatic hernia (CDH). Despite steroids and blood transfusions she remained unstable, and could not be resuscitated following cardiac arrest. Postmortem revealed 39 cm of herniated, necrotic colon. 5-25% of CDH presents after the neonatal period, and while not associated with pulmonary hypoplasia is primarily still a diaphragmatic defect. In late presenting cases, herniation occurs shortly prior to developing symptoms; therefore, an antenatal ultrasound (US) cannot pick it up. If we could diagnose the isolated diaphragmatic defect antenatally, this would allow elective postnatal surgical closure. This is not feasible currently; however, with the advent of antenatal three-dimensional US scans it may be possible in the future.

Item Type: Article
Subjects: WI Digestive system. Gastroenterology
WS Paediatrics. Child health
Divisions: Womens and Childrens > Paediatrics
Related URLs:
Depositing User: Mrs Suganthi Vijayaganesh
Date Deposited: 09 Dec 2014 14:23
Last Modified: 09 Dec 2014 14:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/762

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