الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 199 |  |  |
| | | from | 199 | | |
Abstract
Congenital diaphragmatic (CDH) a malformation that hernia is results from failure of fusion of the different elements that contribute to the formation of the diaphragm. The hernia may occur alone or may occur as one of multiple malformation syndromes. The hernia may occur through foramen of Bochadalek in the posterior portion of diaphragm or through foramen of Morgagni immediately behind the xiphoid process.
Respiratory dysfunction develops as a result of associated anomalies and lung hypoplasia which range from minimal hypoplasia of one side to severe bilateral hypoplasia as a result of compression and inhibition of lung growth. The congenital hernia usually occurs on left side less common on the right and rarely bilaterally.
Prenatal ultrasound is done routinely during prenatal care allowing for assessment of fetal size, anatomy and the prenatal diagnosis of many anaomalies. After the prenatal diagnosis of CDH is made, predicting outcome for these cases remains challenging, cases associated with multiple congenital anomalies are more risky.
Ninety percent of CDH cases are symptomatic within the 1st 24 hours of life and are considered as early presenting CDH however this disease may manifest later on in life causing what’s known as late presenting CDH or go unnoticed until very late in life or even never be diagnosed.
Clinically the infant well be tachypneic with grunting may be cyanotic presenting in the first few hours or days of life but late presentation may be also encountered. Physical signs as mediastinal shift to the opposite side, diminished air entery and scaphoid abdomen also are helpful in diagnosis. Chest x ray performed may show air filled loops of bowels inchest cavity. Prenatal diagnosis by ultrasonography is another way of early diagnosis.
Numerous interventions have been explored in hopes of improving the outcome in newborns with CDH. Extracorporeal membrane oxygnator and high frequency ventilation are now used routinely in the management of severe respiratory failure.
The congenital diaphragmatic hernia may be considered as a surgical emergency. After proper and adequate resuscitation by nasogastric decompression and ventilatory support which may include extracorporeal membrane oxygenation (ECMO). The patient transferred to operating room. After reduction of the hernia, the defect is closed by continuous prolene suture. Agensis of the diaphragm or large defect may require insertion of prothesis as Gortex membrance or other material. Postoperatively ventilatory support is maintained until the infant has satisfactory blood gases, ECMO may also be required.
It is concluded that endoscopic role in congenital diaphragmatic hernia including thoracoscopic and laparoscopic repair may also be beneficial in diagnosis and management of CDH.
Mortality rate remained high especially in severely affected infant despite improved surgical techniques, ventilatory support and medical care.