Kenji Iio

Extracorporeal membrane oxygenation — succesful treatment after repair of congenital diaphragmatic hernia

A case of congenital diaphragmatic hernia successfully treated by extracorporeal membrane oxygenation (ECMO) is reported. A female baby weighing 3.4 kg was admitted 3 h after birth because of respiratory distress. Her left diaphragmatic hernia was repaired 5 h after birth by laparotomy. The AaDO2 levels were higher than 500 mmHg before and after the operation. She was managed by high-frequency ventilation and administration of tolazoine for the first 58 h. These effects were temporary, however, and she reverted into persistent fetal circulation three times. Therefore, ECMO was started at 59 h after birth. When the flow rate of ECMO reached 320 ml/min, the newborn entered a state of complete lung rest. Her general condition improved slowly, and ECMO was successfully terminated after 60 h of bypass. This was the first successful case in Japan.

Lymphangioma of the right diaphragm

Intrathoracic extramediastinal lymphangioma is a rare entity; only four cases have been described in the literature, of which one was in a child. This report describes a 9-year-old girl with an infected lymphangioma of the right diaphragm who presented with chest pain and fever. The preoperative diagnosis was a Morgagni hernia, but the correct diagnosis was made at operation. The lesion was amenable to resection, which proved to be curative.