Embryology of malformations
Prem Puri in Newborn Surgery, 2017
In our SEM study, the observed defects were localized in the PHMP (Figure 1.5). We identified two distinct types of defects: (1) large “dorsal” defects and (2) small “central” defects.79 Large defects extended into the region of the pleuroperitoneal openings. In these cases, the closure of the pleuroperitoneal openings was usually impaired by the massive ingrowth of liver (Figures 1.6 and 1.7). If the defects were small, they were consistently isolated from the pleuroperitoneal openings closing normally at the 16th or 17th day of gestation. Thus, in our embryos with CDH, the region of the diaphragmatic defect was a distinct entity and was separated from that part of the diaphragm where the pleuroperitoneal “canals” are localized. We conclude therefore that the pleuroperitoneal openings are not the precursors of the diaphragmatic defect.
Oesophagus
Michael Gaunt, Tjun Tang, Stewart Walsh in General Surgery Outpatient Decisions, 2018
This condition is often diagnosed and treated shortly after birth. However, it may be asymptomatic and present later in life. Bochdalek hernia. There are persistent pleuroperitoneal canals. It presents in the neonatal period with respiratory distress.Morgagni’s hernia. This parasternal hernia presents in adult life with episodes of pain and tenderness in the subcostal region and intermittent obstructive symptoms. Complete intestinal obstruction may intervene.Central tendon defect is associated with a defect in the pericardium. The intestine herniates into the pericardium.
SBA Answers and Explanations
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury in SBAs for the MRCS Part A, 2018
The diaphragm is a composite musculotendinous structure formed in the embryo by the fusion of 4 separate elements: Septum transversum (giving rise to the non-muscular central tendon)Pleuroperitoneal membranes – Closes the primitive communication between the pleural and peritoneal cavities (forms the bulk of the diaphragmatic muscle)A peripheral rim derived from the body wall (paraxial mesoderm)Dorsal oesophageal mesenchyme (forms the left and right crura)
Surgical and non-surgical management of malignant pleural effusions
Published in Expert Review of Respiratory Medicine, 2018
Deirdre B. Fitzgerald, Coenraad F. N. Koegelenberg, Kazuhiro Yasufuku, Y. C. Gary Lee
Pleuroperitoneal shunts can be inserted at the time of surgery if the lung is found to be trapped [54,55]. The shunt is tunneled under the skin from the chest to the abdomen with the pumping chamber lodged in a subcutaneous pocket overlying the costal margin. One retrospective study reported 95% successful palliation in 160 patients [55]. Shunt-specific complications, including occlusion, infection, and shunt-fracture, developed in 14.8%. Due to the pressure gradient between the pleural and peritoneal spaces, and the 1 ml volume of the pump chamber, fluid sometimes must be manually pumped more than 100 times per day, requiring significant patient commitment. The presence of ascites precludes insertion of these shunts. Bazerbashi et al. utilized an alternative approach of inserting an IPC at thoracoscopy in 84 patients and achieved 76% pleurodesis with few complications [56].
Potential clinical value of catheters impregnated with antimicrobials for the prevention of infections associated with peritoneal dialysis
Published in Expert Review of Medical Devices, 2023
Hari Dukka, Maarten W. Taal, Roger Bayston
Though PD is a very effective treatment, there are some complications and risks to patient health. These can be classified as noninfectious and infectious complications. Noninfectious complications include dialysis fluid drainage problems, pericatheter fluid leaks, abdominal discomfort, dialysis fluid leak into the pleura and electrolyte imbalances [12]. Dialysis fluid drainage problems are often due to constipation, which can be diagnosed with an abdominal X-ray and treated with laxatives. Other drainage issues may be due to deposition of fibrin and thrombi within the catheter, which can be treated with heparin or urokinase. Catheter kinks, which can also lead to drainage problems, require replacement of the PD catheter. Abdominal discomfort may be due to increased intra-abdominal pressure and volume, and some patients develop associated gastroesophageal reflux disease. Dialysis fluid leak into the pleura can occur due to the presence of a pleuroperitoneal fistula. This usually requires discontinuation of PD and transfer to HD treatment. Hypokalaemia is very common in PD patients and requires dietary advice and potassium supplementation.
A case of an intrathoracic abnormality
Published in Journal of Obstetrics and Gynaecology, 2021
Anastasios Liberis, Athanasios Pagkalos, Arzou Halil, Emmanuel Kontomanolis
The optimal treatment of congenital Chylothorax has not been defined. Antenatal management to prevent pulmonary hypoplasia and intrauterine foetal death consists of thoracocentisis, pleuro-amniotic shunts, amnioreduction for polyhydramnios and injection of OK-432 as an alternative to the traditional drainage or pleuroperitoneal shunts. The management of pleural effusion in the postnatal period can be either conservative or surgical. The conservative management consists of a diet with medium-chain triglycerides, pleural drainage, total parental nutrition, replacement of albumin and globulin loss, prevention of infections, drug therapy with somatostatin and octeotide (somatostatin analogue) and the use of positive end expiratory pressure during mechanical ventilation. The surgical one consists of thorascopic pleurodesis, pleuroperitoneal pump, surgical abrasion and the ligation of the thoracic duct to azygous vein anastomosis (Downie et al. 2014).
Related Knowledge Centers
- Peritoneum
- Serous Membrane
- Pleural Cavity
- Pericardium