Hernia diafragmática congénita: presentación de un caso y revisión de la literatura

Janer Sepulveda Agudelo, Carlos Hernán Becerra Mojica, Fredy Ariza Cadena, Diana M. Acosta Puentes


Presentamos el caso de una gestante de 14 años cuyo embarazo fue diagnosticado en el hospital San Juan de Dios de Vélez, Colombia. El producto presentó hernia diafragmática congénita; esta alteración ocurre con una frecuencia de 1 en 2 000 embarazos, por lo cual se hace una revisión detallada de la literatura de esta patología.

Palabras clave

hernia diafragmática congénita; diafragma; surfactante; hipoplasia pulmonar; cirugía fetal

Texto completo:



Goldstein RB. Evaluación ecográfica del tórax fetal. En: Callen PW. Ecografía en Obstetricia y Ginecología. Tercera edición. Buenos Aires: Editorial Médica Panamericana; 1995. p. 364-7.

Harrison MR, Adzick NS, Estes JM, et al. A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA 1994;271:382-4.

Adzick NS, Nance ML. Medical Progress. Pediatric Surgery (First of two parts). N Engl J Med 2000;342:1651-7.

Cannon C, Dildy G.A, Ward R, et al. A population-based study of congenital diaphragmatic hernia in Utah 1988-1994. Obstet Gynecol 1996;87:959-63.

Morin l. Crombleholme TM, D'Alton ME. Prenatal diagnosis and management of fetal thoracic lesions. Semin Perinatol 1994;18:228-53.

Schumpelick V., Steinau G, Schluper I, Prescher A. Surgical Embryology and anatomy of the diaphragm with surgical applications. Surgical Clinics of North America 2000;80:213-39.

Obstetricia de Williams. 20a edición. Buenos Aires: Editorial Médica Panamericana; 1998. p. 849-50.

Schnitzer JJ, Hedrick HL, Pacheco BA, et al. Prenatal Glucocorticoid Therapy reverses pulmonary inmadurity in Congenital Diaphragmatic Hernia in Fetal Sheep. Annals of Surgery 1996;224:430-9.

Sadler TW. Embriología médica de Langman. Séptima edición. Editorial Médica Panamericana: Buenos Aires; 1999. p. 165-70.

Hill R, Heller MB. Diaphragmatic Rupture Complicating Labor. Ann Emerg Med 1996;27:522-4.

Harrison MR, Adzick NS, Nakayama DK et al. Fetal diaphragmatic hernia: fatal but fixable. Semin perinatol 1985;9:103-12.

Nose K, Kamata S, Sawai T, Tazuke Y, Usui N, Kawahara H, Okada A. Airway anomalies in patients with congenital diaphragmatic hernia. J Pediatr Surg 2000;35:1562-5.

Shima H, Guarino N, Puri P. Effect of hyperoxia on surfactant protein gene expression in hypoplastic lung nitrofen- induced diaphragmatic hernia in rats. Pediatr Surg Int 2000;16:473-7.

Suda K, Bigras JL, Bond D, et al. Echocardiographic predictors of outcome in newborns with congenital diaphragmatic hernia. Pediatrics 2000;105:1106-09.

Berk C, Grundy M. "High risk" lecithin/sphingomyelin ratios associated with neonatal diaphragmatic hernia: case reports. Br J Obstet Gynecol 1982;89:250-1.

Hisanaga S, Shirnokawa H, Kashiwabara Y, et al. Unexpectedly low lecithin/sphingomyelin ratio associated with fetal diaphragmatic hernia. Am J Obstet Gynecol 1984;149:905-6.

Moya FR, Thomas VL, Romaguera J, et al. Fetal lung maturation in congenital diaphragmatic hernia. Am J Obstet Gynecol 1995;173:1401-5.

IJsselstijn H, Zimmermann LJ, Bunt JEH, Jongste JC, Tibboel D. Prospective evaluation of surfactant composition in bronchoalveolar lavage fluid of infants with congenital diaphragmatic hernia and of age-matched controls. Critical Care Medicine 1998;26:573-80.

Sharland GK, Lockhart SM, Heward AJ, Aplan D. Prognosis in fetal diaphragmatic hernia. Am J Obstet Gynecol 1992;166:9-13.

Benacerraf BR, Adzick NS. Fetal diaphragmatic hernia: Ultrasound diagnosis and clinical outcome in 19 cases. Am J Obstet Gynecol1987;156:573-6.

Sebire NJ, Snijders JM, Davenport M, Greenough A, Nicolaides KH. Fetal nuchal translucency thickness at 10-14 weeks' gestation and congenital diaphragmatic hernia. Obstet Gynecol 1997;90:943-6.

Weinstein S, Stolar JH. Urgencias quirúrgicas en recién nacidos: Hernia diafragmática congénita y oxigenación con membrana extracorpórea. En: Altman PR, Stylianos S. Clínicas pediátricas de Norteamérica. México: Interamericana McGraw-Hill; 1993. p. 1415-34.

Thibeault DW, Haney B. Lung volume, pulmonary vasculature, and factors affecting survival in congenital diaphragmatic hernia. Pediatrics 1998;101:289-95.

Hsieh YY, Chang FC, Tsai HD, Hsu TY, Yang TC. Accuracy of sonography in predicting the outcome of fetal congenital diaphragmatic hernia. Chung Hua I Hsueh Tsa Chih (Taipei) 2000;63:751-7. Resumen.

Flake AW, Harrison MR. Fetal Therapy: Medical and surgical approaches. En: Creasy RK, Resnik R. Maternal Fetal Medicine principles and practice. Third Edition. Philadelphia: WB Saunders Company; 1994. p. 376-7.

Dommergues M, Louis-Sylvestre C, Mandelbrot L, et al. Congenital diaphragmatic hernia: Can prenatal ultrasonography predict outcome? Am J Obstet and Gynecol 1996;174:1377-81.

Sullivan KM, Adzick NS. Cirugía fetal in Varner Mw. Clínicas obstétricas y Ginecológicas. México: Interamericana McGraw Hill; 1994. p. 325-28.

Flake AW, Crombleholme TM, Johnson MP, Howell LJ, Adzick NS. Transactions of the twentieth annual meeting of the society for maternal-fetal medicine. Am J Obstet Gynecol 2000;183:1059-66.

Quinn TM, Adzick NS. Cirugía fetal in Reece EA Varner Mw. Clínicas de Ginecología y Obstetricia, Temas Actuales. México: McGraw Hill; Interamericana; 1997. p. 129-42.

Walsh DS, Hubbard AM, Olutoye OO et al. Assessment of fetal lung volumes and liver herniation with magnetic resonance imaging in congenital diaphragmatic hernia. Am J Obstet Gynecol 2000; 183:1067-69.

Badalian SS, Fox HE, Chao CR, Timor-Tritsch IE, Stolar ChJ. Fetal breathing characteristics and postnatal outcome in cases of congenital diaphragmatic hernia. Am J Obstet Gynecol 1994;171:970-6.

Fox HE, Badalian SS Fifer WP. Patterns of fetal perinasal fluid flow in cases of congenital diaphragmatic hernia. Am J Obstet Gynecol 1997;176:807-13.

Kays DW, Langhman MR, Ledbetter DJ, Talbert JL. Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Annals of Surgery 1999;230:340-351.

Antunes MJ, Greenspan JS, Cullen JA, et al. Prognosis with preoperative pulmonary function and lung volume assessment in infants with congenital diaphragmatic hernia. Pediatrics 1995;96:1117-22.

Heiss KF, Clark RH. Prediction of mortality in neonates with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation. Crit Care Med 1995;23:1915-9.

Miguet D, Claris O, Lapillonne A, et al. Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 1994;22:77-82.

Dexowski SA, Holtzman RB. Surfactant replacement therapy an update on applications. Pediatric Clinics of North America. Philadelphia: WB Saunders Company; 1998. p. 549-72.

Suen HC, Catlin EA, Ryan DP, et al. Biochemical immaturity of lungs in congenital diaphragmatic hernia. J Pediatr Surg 1993;28:471-7.

Ballard RA, Ballard PL, Creasy RK, et al. Respiratory disease in very-low birth weight infants after prenatal thyrotropin-releasing hormone and glucocorticoid. Lancet 1992;339:510-5.

Hedrick HL, Pacheco BA, Losty PD, et al. Dexamethasone increases expression of surfactant associated protein mRNA in rats with nitrofen-induced congenital diaphragmatic hernia. Surgical Forum 1995;XLVI:654-7.

Harrison MR, Adzick NS, Longaker MT, et al. Successful repair in utero of a fetal diaphragmatic hernia after removal of the herniated viscera from the left thorax. N Engl J Med 1990;322:1582-4.

Difiore JW, Fauza DO, Slavin R, et al. Experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia. J Pediatr Surg 1994;29:248-56.

Yeh TF, Torre JA, Rastogi A, et al. Early postnatal dexamethasone therapy in premature infants with severe respiratory distress syndrome: a double-blind, controlled study. J Pediatr 1990;117:273-82.

Brozanski BS, Jones JG, Gilmour C, et al. Effect of pulse dexamethasone therapy on the incidence and severity of chronic lung disease in the very low birth weight infant. J Pediatr; 1995;126:769-76.

Hardy Hendren III W. Pediatric Surgery. Pediatrics 1998;102:275-7.

Quintero RA, Morales WJ, Bornick PW, Johnson PK. Minimally invasive intraluminal tracheal occlusion in a human fetus with left congenital diaphragmatic hernia at 27 weeks' gestation via direct fetal laryngoscopy. Prenatal and Neonatal Medicine 2000;3:13.

Harrison MR, Albanese CT, Hawgood SB, Farmer DL, Farrell JA, Sandberg PL, Filly RA. Fetoscopic temporary tracheal occlusion by means of detachable balloon for congenital diaphragmatic hernia. Am J Obstet Gynecol 2001;185:730-3.

Harrison MR, Mychaliska GB, Albanese CT, et al. Correction of congenital diaphragmatic hernia in utero: IX. Fetuses with poor prognosis (Liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg 1998;33:1017-23.

comments powered by Disqus

Métricas de artículo

Cargando métricas ...

Metrics powered by PLOS ALM

Copyright (c) 2016 Revista Colombiana de Obstetricia y Ginecología

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.

ISSN Impreso       0034-7434 

ISSN Electrónico   2463-0225