A Case of Central Tendon Defect Complicated by Intestinal Strangulation and Postoperative Mediastinal Abscess

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  • 嵌頓にて発症し術後縦隔膿瘍を来した central tendon defect の1 例
  • 症例報告 嵌頓にて発症し術後縦隔膿瘍を来したcentral tendon defectの1例
  • ショウレイ ホウコク カントン ニテ ハッショウ シ ジュツゴ ジュウカク ノウヨウ オ キタシタ central tendon defect ノ 1レイ

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Abstract

Late-onset congenital diaphragmatic hernia (CDH) complicated by intestinal strangulation is rare, especially in central tendon defect subtype. As far as we have investigated, no cases of late-onset CDH complicated by postoperative mediastinal abscess have ever been reported until now. A one-year-old female, with a past surgical history of ventricular septal defect repair at the age of three months, was admitted to our hospital complaining of dyspnea. Emergency laparotomy diagnosed the patient as having the central tendon defect type of CDH with hernia sac, accompanied by incarceration of the transverse colon and left hepatic lobe. Partial colectomy and direct closure of the defect were performed. Postoperatively, she continued with a high fever, and she subsequently developed a mediastinal abscess of 5 cm in diameter. Emergency abscess drainage was then undertaken on postoperative day 12. Because an echo-guided percutaneous drainage or an open-drainage via median sternotomy was considered infeasible, we instead performed thoracoscopic drainage. The postoperative recovery was favorable and noneventful. A postoperative mediastinal abscess after central tendon defect repair is extremely rare, and thoracoscopic abscess drainage may be a feasible option for treatment.

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