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Laparoscopic surgery of diaphragmatic sliding hernia in an infant

Yasen Georgiev, Djuliana Stoilova, Georgi Mladenov, Aleksandar Zlatarov


Introduction: The diaphragmatic hernia (DH) is a condition in which there is an upwards dislocation of parts of the stomach or the whole stomach from the abdomen to the chest. Three types are identified: the sliding hernia, type I, with dislocation of the cardia into the posterior mediastinum; type II, with normally positioned cardia but misplaced gastric fundus and type III, with dislocation of both.

Materials and methods: This is a case report of a two-year-old infant with DH type I. Although the patient was born from a normal pregnancy in his postpartum period he suffered intraamniotic pneumonia. When he was two-months old during an emergency hospitalization due to acute respiratory failure and pneumonia of unknown origin, he was further diagnosed with gastroesophageal reflux disease. Both findings raised the suspicion of possible DH and a confirmation was made a few months later after hospitalization again due to pneumonia. A computed tomography of the chest revealed a 30-40mm sliding DH. After a consult with a paediatric surgeon a 6-month diet and close observation were recommended. If the symptoms wouldn`t resolve further operation was endorsed.

Results: At the age of two the patient was scheduled for an elective surgery. At first a fiberoptic bronchoscopy was performed after the request by the anaesthesiologists to exclude tracheal stenosis. Next, laparoscopy was done showing an enlarged hiatal opening and axial DH with a length of the sac of around 3cm. The distal part of the oesophagus was mobilized in the mediastinum. A postoperative pneumonia occurred but it responded well to antibiotic treatment. The condition of the patient was significantly improved by this operative intervention.

Conclusions: The DH is most commonly seen in adult patients. Regardless of age its treatment is largely surgical. If delayed or done on emergency basis the mortality is high.


diaphragmatic hernia; paediatric surgery



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