Late congenital diaphragmatic hernia, a case report

Abstract

BACKGROUND: Congenital diaphragmatic hernia (CDH) is the result of incomplete closure of the pleuroperitoneal canal during the period of fetal development; this diaphragmatic defect allows organs and abdominal content to protrude into the thoracic cavity. Ninety percent of cases are diagnosed prenatally or immediately in newborns. Late presentation hernia is defined as CDH diagnosed after the neonatal period and is relatively rare, with an incidence between 5-30% of cases. Clinical manifestations outside the neonatal period are usually more subtle and nonspecific and present as a diagnostic challenge. CASE REPORT: We present the case of a 3-month-old, eutrophic infant who was brought to the emergency department with 72 hours of evolution alimentary vomiting, irritability and hyporexia. On physical examination he presented abolition of vesicular murmur in the left pulmonary field, so a chest X-ray was performed, which incidentally showed images compatible with intestinal contents in the left thoracic cavity, making the diagnosis of CDH. EVOLUTION: The patient was admitted and corrective surgery of the defect was performed with open technique. The procedure was performed without complications with favorable postoperative evolution. The patient was discharged in good condition 10 days postoperatively. Two subsequent controls were performed, one 15 days and the other one month after hospital discharge; the patient was clinically asymptomatic and without sequelae. CONCLUSION: Late congenital diaphragmatic hernia shows a wide spectrum of clinical presentations, from being asymptomatic to respiratory or digestive symptoms; for this reason it is a diagnostic challenge and it is essential to maintain clinical suspicion in patients with non-specific symptoms. Early surgical intervention is necessary to avoid complications and to favor a good prognosis. The technique used for the resolution of this pathology will depend on each case.