Congenital diaphragmatic hernia: Prognostic value of hernia sac and size of defect

Introduction: Congenital diaphragmatic hernia (CDH) is a congenital malformation with challenging management. The aim of this study was to evaluate the effect of the presence of hernia sac and defect size on the prognosis of CDH in Tabriz children’s hospital. Methods: In this prospective study, all the infants with the diagnosis of CDH that were admitted to the Tabriz children’s hospital since 2016-2019 were enrolled. The presence or absence of a hernia sac was evaluated, and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcomes, including instability, duration of mechanical ventilation, mortality rate, or hospital discharge were obtained and analyzed. Results: Over the study period, 30 patients with CDH met the inclusion criteria, consisting of 15 males and 15 females. Fifteen cases were diagnosed during the first 24 hours of life and 16 cases experienced hypoxia in the first hour after birth. Defect size was significantly smaller in survived patients (P=0.041). Postoperative death occurred in 9 (42.85%) patients without a hernia sac. Results showed that none of the cases with hernia sac expired (P=0.035). Conclusion: In our study, the presence of the hernia sac was related to a lower postoperative mortality rate. Defect size in survived group was also smaller. It can be suggested that the presence of hernia sac and lower diameter of defect size act as good prognostic factors in the outcome of patients with CDH

Polypoid heterotopic gastric mucosa: in terminal ileum causing extensive lower gastrointestinal bleeding without Meckel’s diverticulum: a case report

Abstract Background Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death. Case presentation This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel’s diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel’s diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery. Conclusion Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding

Primary Hydatid Cyst of Umbilicus, Mimicking an Umbilical Hernia

Hydatid cyst caused by Echinococcus granulosus demonstrates an endemic infection in several countries such as Middle Eastern countries. Liver is the most frequently involved organ, followed by the lung. The case we present is solitary primary localization of cyst in abdominal wall which is extremely rare. A 57-year-old woman presented with an abdominal wall lesion in umbilical area that had been evolving for about 2 years with recent complaint of pain and discomfort. We detected a midline abdominal mass 12⁎13 centimeters in diameter which was bulged out in umbilicus. Preoperative clinical diagnosis of incarcerated umbilical hernia was made due to its physical examination while surgical exploration disproved the primary diagnosis and we found cystic mass adherent to superficial fascia without any communication to peritoneal space. The cyst was excised completely without any injury or perforation of containing capsule. The diagnosis of hydatid cyst was confirmed by histopathological examination of specimen. The retrograde evaluation showed no involvement of other organs. The patient was followed for two years and no recurrence of hydatid disease has been observed. Hydatid cyst should be considered as a differential diagnosis of abdominal wall and umbilical lesions especially in endemic regions