Guo Rui, Zhang Lina, Zhang Shisong, Xu Hongxiu, Zhai Yunpeng, Zhao Huashan, Lv Longfei
Department of Thoracic and Tumor Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
Department of Thoracic and Tumor Surgery, Jinan Children's Hospital, Jinan, China.
Front Pediatr. 2023 Feb 1;11:1115101. doi: 10.3389/fped.2023.1115101. eCollection 2023.
Congenital diaphragmatic hernia (CDH) is a scarce birth defect. It is called late-presenting CDH when symptoms are found after 1 month of life. The clinical manifestations of late-presenting CDH are diverse, among which the most fatal is the cardiac arrest caused by tension gastrothorax. The disease is rare, can easily lead to death owing to improper emergency treatment. This report illustrates the emergency treatment of late-presenting CDH with tension gastrothorax in three Chinese children.
Three children presented to emergency room with a sudden dyspnea, diagnosed accurately by x-ray or computed tomography. In case 1, the gastric tube could not be inserted at the first attempt, and the child cried incessantly. Cardiac arrest occurred when the gastric tube was re-inserted. After cardiopulmonary resuscitation and placement of a thoracic drainage tube, a large amount of gas and stomach contents were drained. Laparoscopic surgery was performed. The patient died of sepsis. In case 2, the gastric tube could not be inserted at the first attempt; consequently, emergency surgery was considered instead of retrying. After the patient was anesthetized, a gastric tube was successfully placed. Subsequently, a large amount of gas and gastric contents was drained, and thoracoscopic surgery was performed. The patient recovered evenly. In case 3, the gastric tube was successfully inserted at the first attempt; however, the vital signs were unstable due to poor drainage of the gastric tube. We injected 20 ml of iohexol into the stomach tube for angiography and dynamic chest film monitoring. After adjusting the position of the stomach tube, the stomach collapsed completely. Thoracoscopic surgery was performed. The patient recovered evenly.
Early diagnosis is essential for children with late-presenting CDH complicated by tension gastrothorax. Fully collapsing the stomach is a key step in emergency treatment. In addition, gastric tube insertion is the first choice. In children with difficulty in gastric tube placement at the first attempt, the gastric tube can be placed under anesthesia, and emergency surgery performed simultaneously. Endoscopic surgery can be the first choice in cases of complete stomach collapse.
先天性膈疝（CDH）是一种罕见的出生缺陷。出生1个月后出现症状的称为迟发性CDH。迟发性CDH的临床表现多样，其中最致命的是张力性胃胸腔导致的心搏骤停。该病罕见，因急救处理不当易导致死亡。本报告阐述了3例中国儿童迟发性CDH合并张力性胃胸腔的急救处理。
3例患儿因突发呼吸困难就诊于急诊室，通过X线或计算机断层扫描准确诊断。病例1，首次尝试插入胃管未成功，患儿哭闹不止。再次插入胃管时发生心搏骤停。经过心肺复苏和放置胸腔引流管后，引出大量气体和胃内容物。实施了腹腔镜手术。患者死于败血症。病例2，首次尝试插入胃管未成功；因此，考虑急诊手术而非再次尝试。患者麻醉后，成功放置胃管。随后，引出大量气体和胃内容物，并实施了胸腔镜手术。患者顺利康复。病例3，首次尝试成功插入胃管；然而，由于胃管引流不畅，生命体征不稳定。我们向胃管内注入20 ml碘海醇进行血管造影和动态胸部X线监测。调整胃管位置后，胃完全塌陷。实施了胸腔镜手术。患者顺利康复。
对于迟发性CDH合并张力性胃胸腔的患儿，早期诊断至关重要。使胃完全塌陷是急救处理的关键步骤。此外，插入胃管是首选方法。对于首次尝试放置胃管困难的患儿，可在麻醉下放置胃管，并同时进行急诊手术。在胃完全塌陷的情况下，内镜手术可作为首选。
