2024 Volume 60 Issue 5 Pages 813-819
We report a case of severe congenital diaphragmatic hernia in which organs that herniated into the thoracic cavity were returned to the abdominal cavity and a silo was created before the introduction of extracorporeal membrane oxygenation (ECMO). Following ECMO weaning, repair was performed using an abdominal muscle flap. The infant was born at 38 weeks weighing 3,018 g, with Apgar scores of 3 and 4. Progressive neonatal persistent pulmonary hypertension (PPHN) was observed, and despite initiating nitric oxide inhalation therapy, the herniated organs exerted significant pressure on the ventricles, making blood pressure maintenance challenging and exacerbating the PPHN, along with progressing liver enlargement due to fluid overload. It was determined necessary to remove the swollen herniated intrathoracic organs before ECMO initiation. An initial abdominal surgery on day 1 revealed herniated organs including the left lobe of the liver, the entire stomach, spleen and accessory spleen, the entire small intestine, and the colon from the cecum to the descending colon. Almost the entire left diaphragm was defective. The herniated organs were repositioned back into the abdominal cavity, and a silo was constructed, followed by ECMO initiation on the same day. On day 6, ECMO weaning was initiated, and the diaphragm was repaired using a flap made from the transverse and internal oblique abdominal muscles on day 7. At 9 years of age, although mild scoliosis and moderate pectus excavatum are noted, the patient is recurrence-free, with no growth retardation or developmental delays.
