ABSTRACT 858

Abstract

Background and aims: Congenital diaphragmatic hernia occurs as a result of defect in the closure of pleuroperitoneal pleat. It is usually presented with respiratory distress after birth and rarely presentation is delayed. Mild or severe symptoms, such as respiratory distress and obstruction of gastrointestinal tract may be observed. Aims: We report a case of late presenting congenital diaphragmatic hernia. Methods: A 10 month-old male infant admitted to our hospital with respiratory distress. He had recurrent bronchiolitis with no history of trauma. In emergency room he was restless and agitated. His skin was pale and cold. There was severe respiratory distress, tachycardia,pulseless and decrease of respiratuary sounds with auscultation on the right part of his chest. Oronasal mask O2 is administered but O2 saturation of patient didn't reach over than 90%. We applied serum physiologic boluses (20 ml/ kg) twice. Laboratory findings:Hb:10,2 g/dl, WBC:28840/mm3, PLT:475000/mm3, venous blood gas revealed pH:7,02, pCO2:50,5 mmHg, HCO3:13 mmol/L, BE:-17,3, biochemical findings were normal. Chest X-Ray revealed radioopacityin right hemithorax with mediastinal shift. Pleural effusion was suspected and ultrasound imagination demonstrated motile bowels in right hemithorax and patient underwent computerized tomography scan for confirmation of congenital diaphragmatic herni. Results: The patient's diagnosis is Bochdalek hernia and with surgical therapy, he recovered without complication. Conclusions: Late presenting congenital diaphragmatic hernia may have varying presentation .The respiratory distress can be severe and may be associated with circulatory insufficiency, requiring aggressive resuscitative measures. Emergency room physician must consider congenital diaphragmatic herni in patients representing with unexplained acute respiratory symptoms.