ABSTRACT 864

Abstract

Background and aims: Late presentation of congenital diaphragmatic hernia is %5-30 of all congenital diaphragma hernia cases. Misdiagnosis can result in significant morbidities. We will present a case of late presenting congenital diaphragmatic hernia. Results: The patient is a 17 month old girl with no significant medical history. She was presented with severe respiratory distress. Bowel loops in the left hemithorax with air-fluid levels were detected in chest X-ray and diaphragmatic hernia was seen in her computed tomography examination. She was referred to our center for urgent operation. On physical examination, circulatory disturbance, ciyanosis, and abdominal distantion were detected. Her O2 saturation was 60% and she was both tachycardic (180 bpm) and tachypneic (58 bpm); and her blood pressure was 60/35 mmhg. On the chest X-ray, patient's heart and trachea were seen shifted into the right hemithorax. The patient was operated within an hour. At the surgery, herniated 45 cm necrotic small bowel and stomach were observed in the chest due to 2 cm defect in the central part of the diaphragma and the defect was repaired primarily. The herniated organs were pulled into the abdomen and after the resection and anastomosis of the necrotic small bowel segment, the defect was primarily repaired. She had an uneventful recovery period; was extubated at 4th day and was discharged at 10th day after the surgery. Conclusions: Late presentation of congenital diaphragmatic hernia may be confused with many situation and is difficult to diagnose without clinical suspicion. Accurate diagnosis and early surgical intervention preventing possible complications.