Iatrogenic intrapericardial diaphragmatic hernia diagnosed by cardiovascular magnetic resonance

Intrapericardial diaphragmatic hernias are very uncommon and are most typically caused by high-force blunt trauma. Other iatrogenic causes such as prior surgical formation of a pericardial window have been described, but are exceedingly rare. We present a case of an intrapericardial diaphragmatic hernia in a patient with a prior pericardial window in which the diagnosis was unclear using conventional imaging modalities, but was established using cardiovascular magnetic resonance

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

Multiple spontaneous small bowel anastomosis in premature infants with multisegmental necrotizing enterocolitis.

BACKGROUND/PURPOSE: Fulminant necrotizing enterocolitis (NEC) may result in extensive bowel necrosis. Resection of involved segments may result in short bowel syndrome. Multiple stomas result in complications and further loss of intestinal length with closure. METHODS: Two patients with extensive multisegmental NEC were treated with an intraluminal stent without anastomosis. All necrotic intestine was resected and the remaining viable intestine was lined up over a feeding tube without anastomosis of the intestinal segments. One patient had a diverting jejunostomy and mucous fistula with the tube used to orient the defunctionalized intervening intestinal segments. The second patient had the bowel left in continuity with the tube brought into the jejunem proximal to the first area of resection and distally brought out through the tip of the appendix. Both tubes were brought through the abdominal wall and secured in a loop. RESULTS: Contrast study findings showed that the intestinal segments had auto-anastomosed. In the first case the tube was left in place and intestinal continuity was restored. The patient is now 4 years old and takes full enteral feeds. The latter patient had the enterostomy tube removed at the time of the contrast study, but only tolerated partial feedings and died at 1 year of total parenteral nutrition-related liver failure. CONCLUSION: The technique eliminates nonviable bowel, maximizes length, avoids multiple stomas, and may help avoid reoperation