Congenital Paraesophageal Hernia in Infants and Children: Our Experience
Journal Title: New Indian Journal of Surgery - Year 2018, Vol 9, Issue 4
Abstract
Background: Congenital Paraesophageal Hernia (CPH), though rare in the pediatric age group, can cause significant respiratory and gastrointestinal symptoms ranging from repeated attacks of chest infection and vomiting to serious complications like intrathoracic gastric volvulus. Our experience with five such cases over five years is presented in this study. Material and Methods: Five children (4 males:1 female) were diagnosed and managed in our department as congenital paraesophageal hernia from January 2013 through December 2017. The characteristics recorded included age at presentation, sex, duration of symptoms, investigation, associated anomalies, operative procedures, side and size of hernia were recorded from the operative notes. Follow up period ranged from 3 months to 4.5 years. Results: Age at presentation ranged from 6 months to 3years (mean 1.6 years). Two patients presented with recurrent vomiting, 2 had recurrent chest infection and one baby presented with respiratory distress. Duration of symptoms ranged from one week to eight weeks (mean 3 weeks and four days). One child had associated congenital heart disease and one had right inguinal hernia. Computed Tomography in 2 and upper GI contrast in 3 patients confirmed the diagnosis. Final diagnosis was confirmed intra-operatively, with right sided defect in all the 5 cases. Repair of the crura only was done in 2 patients while as Nissen’s fundoplication and gastropexy were added in one and two patients, respectively. Herniation recurred in one case in the immediate post-operative period and was managed by redo-repair of hernia with gastropexy. All the patients were followed over a mean period of 2.5 years and are symptom free with optimal weight gain. Conclusion: Congenital paraesophageal hernia should be strongly suspected in case of repeated chest infection or repeated attacks of vomiting or respiratory distress. Chest x-ray followed by contrast upper GI study are simple investigations to confirm the diagnosis and computed tomography may rarely be needed. Gastropexy and/or an anti-reflux procedure, in select cases, may be added to surgical reduction of the hernia with repair of crura.
Authors and Affiliations
Kumar Abdul Rashid
Keywords
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- EP ID EP548082
- DOI 10.21088/nijs.0976.4747.9418.8
- Views 90
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