Presentation Of Congenital Diaphragmatic Hernia Research Articles

Late presentation of congenital diaphragmatic hernia in children: A single-institution experience

Background: Congenital diaphragmatic hernia (CDH) with late presentation beyond the neonatal period is rare and often misdiagnosed, with delayed treatment. We report the management of a series of patients that presented after the neonatal period.Patients and method: we reviewed our experience over 4 years (2015-2019) in a single institution to determine the factors for late presentation of congenital diaphragmatic hernia, associated anomalies, complications and its management. Results: We had six patients diagnosed as late presenting CDH and operated in our institution over 4 years . The patients ranged in age from one year to 10 years with males to females ratio 2:1. All the hernia defects were left sided. Except one patient all have abnormal gut rotation. The mode of presentations were ; one patient presented with gastric perforation due to misdiagnosis of pneumothorax and ICD placement. Another one had irreducible gut gangrene, 2 cases have left lobe of liver along with small bowel, colon and spleen and stomach, The other 2 patients had small bowel, colon and spleen and stomach as hernia content. All cases were managed by primary repair of defect with interrupted non absorbable suture through transabdominal approach. Two cases had post op pleural effusion and pneumothorax and required intercostal tube placement, and all the patient were kept in intensive care for 48 hours but without any ventilator support.Conclusions: There should be a high index of suspicion in every case presenting with persistent vomiting along with abdominal pain, recurrent pneumonia, chronic respiratory conditions or acute abdominal condition with doubtful x-ray chest.

Thoracoscopic diagnosis and repair of central congenital diaphragmatic hernia in a neonate: A case report of a rare entity

Abstract Introduction Central congenital diaphragmatic hernia that involves a central tendon defect is a very rare form of diaphragmatic hernias. Experience in the thoracoscopic repair of congenital diaphragmatic hernia has expanded in recent years, but this expansion was mainly for the most common type; the posterolateral. We report a case of central congenital diaphragmatic hernia, which is supposed to be the case number seventeen of those reported in literature. And we report the first use of thoracoscopic repair in such rare entity. Case presentation We present a case report of a Bengali neonate who had a prenatal diagnosis of left congenital diaphragmatic hernia, which was supposed to be the usual posterolateral type. As we usually approach such cases by thoracoscopy, the patient had an intraoperative diagnosis of central congenital diaphragmatic hernia. The defect was amenable to a successful thoracoscopic repair. Conclusion The rare neonatal central congenital diaphragmatic hernia could present as a left sided herniation that clinically resembles the usual posterolateral congenital diaphragmatic hernia. Thoracoscopic approach offers a tremendous tool for diagnosis as well as the management of this kind of presentation of a central congenital diaphragmatic hernia.

Gastric outlet obstruction with perforation. A rare presentation of left-sided adult Morgagni hernia

Adult presentation of congenital diaphragmatic hernia (CDH) is rare. Out of the three varieties of CDH, Morgagni hernia is the rarest of all. Though most of them are asymptomatic and may be incidentally detected, they may also present in the emergency setting with respiratory or gastrointestinal features like obstruction or strangulation. Gastric outlet obstruction is a rare manifestation of adult Morgagni hernia. We present a case of adult left-sided Morgagni hernia with features of gastric outlet obstruction complicated with perforation.

Congenital Diaphragmatic Hernia Presenting in a 7-Day-Old Infant.

A 7-day-old male infant presented to the emergency room after respiratory distress was noted at an outpatient well child check. On exam, he was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. The infant was transported to a tertiary care facility where the defect was repaired without complication. Interestingly, the mother had a history of a normal antenatal ultrasound, completed at 19 + 2 weeks of gestational age. This case report summarizes the challenges of diagnosing late-presenting congenital diaphragmatic hernia, associated malformations, possible etiologies, and prognosis.

Late presentation of congenital diaphragmatic hernia: A diagnostic dilemma

Congenital diaphragmatic hernias are commonly symptomatic within 24 hours after birth, but late presentation is not uncommon. Late presentation of congenital diaphragmatic hernia poses diagnostic difficulties as clinical picture are vague, and more commonly presented with non-specific gastrointestinal and respiratory symptoms. Due to the vague and non-specific clinical presentation, clinician faces a diagnostic dilemma resulting in delay in diagnosis and many a times an inappropriate management. This article reports 2 cases of late-presenting congenital diaphragmatic hernia (over the period of 6 months from September 2014 to February 2015) in National Institute of Disease of Chest and Hospital (NIDCH). In first case, she was diagnosed as right-sided tubercular pleural effusion and was treated with CAT-1 anti-tubercular therapy for 6 months without any clinical improvement. Later CT scan of chest was done and diagnosed as a case of congenital diaphragmatic hernia. The second case was diagnosed as a left-sided hydropneumothorax and treated with left tube thoracostomy. During removal of the intercostal chest tube, some fatty tissue was pulled out of the thoracostomy site. In NIDCH, she was diagnosed as a case of diaphragmatic hernia by barium follow-through. Both cases were diagnosed as Bochdalek hernia during the repair of the hernia defect via thoracotomy.

Late presentation of congenital diaphragmatic hernia in Sub-Saharan Africa: A call for screening and prompt treatment

Background: Congenital diaphragmatic hernias (CDHs) are uncommonly seen anomalies of the diaphragm in our environment. They present late posing great difficulty in diagnosing and management. Objective: To review our experience in the management of CDH and to draw attention to misdiagnosis and mismanagement of cases. Methodology: A prospective study on all patients with CDH from August 2008 to June 2014. Protocols and questionnaire were designed for diagnosis, management, and follow-up of the cases. Results: Eight patients (five males and three females) with age between 15 days and 8 years (median = 5 months) were recruited. Seven (87.5%) cases had hernia of Bochdalek hernia (BH) (one on the right and six on the left) and one had Morgagni hernia (MH). All patients were underweight with a median of 10.7 kg (range = 3.0–17.6 kg). Five (62.5%) cases had recurrent cough, respiratory distress, and postprandrial vomiting; one patient (12.5%) presented with chronic constipation raising the suspicion of Hirschsprung's disease. Diagnosis was confirmed with plain chest X-ray in six patients; upper gastrointestinal contrast in three cases (37.5%) while the patient with chronic constipation and anterior CDH had barium enema, and two patients had chest ultrasound to confirm diagnosis. One patient underwent laparoscopic repair of an MH, and seven patients had open transabdominal repair of BH. The median age at surgery was 7 months (36 days – 96 months). The diaphragmatic defect dimension ranged from 3 cm to 11 cm. Only one patient had 24 h Intensive Care Unit care postsurgery, and median length of stay was 11.8 days (range = 5–27 days) in the open group and only 4 days in the laparoscopic case. Conclusions: CDHs were uncommon and presented late in our practice. Modalities of management require meticulous and structured professional care. We recommend that postmortem should be done in stillborn and infants' deaths to determine true incidence of CDH and confirm possible high hidden mortality.

A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia

ABSTRACTCongenital diaphragmatic hernia is a well-described condition that occurs in about 1 in 5,000 live births. A majority of the patients are diagnosed either antenatal or will present in the first few hours of life with respiratory distress. Presentation in adults is extremely rare and accounts for about 5 to 25% of diaphragmatic hernias. Patients, who present with late diaphragmatic hernias, complain of a wide variety of symptoms and diagnosis can be difficult. It consists of herniation of bowel, and occasionally solid organs, into the chest. It is more common on the left side (seen in 80% of cases), as the liver provides a relative barrier on the right side. The major clinical problem is pulmonary hypoplasia, a result of the lung having failed to developin uteroas the thoracic cavity is filled with abdominal contents. These congenital diaphragmatic defects have also been described in the adult population, and the widespread use of computed tomography has led to the recognition that these hernias are not uncommon and are often asymptomatic.How to cite this articleSanjay S, Pramila VVS, Shukla AK, Nagesh R. A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia. J Med Sci 2016;2(4):65-67.

Congenital Right Morgagni Hernia Presenting in an Adult-a Case Report.

Patients with congenital diaphragmatic hernias (CDH) usually present in the neonatal period with respiratory distress. Delayed presentation of CDH in adults is rare and difficult to diagnose. We present a 42-year-old female patient who came with complaints of epigastric pain and breathlessness on exertion. X-ray and CT scan of the chest revealed a right-sided Morgagni hernia. The contents of the hernia were reduced and a primary tension free repair of the hernia defect was done through laparotomy. The postoperative course was uneventful. A strong clinical suspicion and good interpretation of radiological images help diagnose CDH which present late. Prompt surgical repair is mandatory and the outcomes are usually favorable. Primary repair is usually successful; however, mesh repair may be required for larger defects.

Acute intestinal obstruction: A rare presentation of left sided adult congenital diaphragmatic hernia

A diaphragmatic hernia is defined as a communication between the abdominal and thoracic cavities, with or without abdominal contents in the thorax. It is usually diagnosed among newborns, but late presentation of congenital diaphragmatic hernias has also been reported with an incidence of 5 to 25%. Intestinal obstruction due to obstructed diaphragmatic hernia is very rare and represents a considerable diagnostic challenge. Herein, we report the case of an obstructed diaphragmatic Bochdalek-type hernia complicated by acute intestinal obstruction.

In need of a patch UP: Recurrent congenital diaphragmatic hernia presenting with a large pleural effusion

We report a case of recurrent congenital diaphragmatic hernia (CDH) presenting with a large unilateral pleural effusion. A 12-year old boy who had a left sided CDH repaired in the neonatal period, presented with fever, lethargy, and non-productive cough. Chest radiograph demonstrated a loculated pleural effusion. Computed tomography scan revealed recurrent herniation of abdominal contents. To our knowledge, this is the first reported case of a recurrent congenital diaphragmatic hernia presenting with large pleural effusion.

Delayed Presentation of Congenital Diaphragmatic Hernia as Heart Failure

Congenital diaphragmatic hernia (CDH) is rare congenital condition that primarily presents in infants. Bochdalek hernia is the most common of them. Late presentation is unusual, and in most cases is diagnosed in adolescents or early adulthood. Morgagni hernia is the one that usually presents late in adults. The finding of CDH in adults is mostly incidental. We report a case of CDH, posterolateral (Bochdalek type), with left lung hypoplasia, in a 60 year old female, who primarily presented with sudden shortness of breath.

Lung function over the first 3 years of life in children with congenital diaphragmatic hernia.

Infants with congenital diaphragmatic hernia (CDH) have variable degrees of pulmonary hypoplasia at birth. Few reports of lung function over the first years of life exist in this group of children. Pulmonary function abnormalities correlate with severity of neonatal disease and intensity of neonatal therapies needed. We also hypothesized that longitudinal measurements of lung function over the usual period of rapid lung growth would lend some insight into how the lung remodels in CDH infants. Ninety-eight infants with CDH between 11 days and 44 months of age underwent pulmonary function testing (PFT) on 1-5 occasions using the raised volume rapid thoracic compression technique. Demographic data were also collected. Forced expiratory flows were below normal. Total lung capacity was normal, but residual volume and functional residual capacity were elevated. Children requiring patch closure, ECMO, or pulmonary vasodilators generally had lower lung functions at follow up. Additionally, longer duration of mechanical ventilation correlated with worse lung function. Lung functions of survivors of CDH remain abnormal throughout the first 3 years of life. The degree of pulmonary function impairment correlated both with markers of the initial degree of pulmonary hypoplasia and the duration of mechanical ventilation. Understanding the relationship between the phenotypic presentation of CDH and the potential for subsequent lung growth could help refine both pre- and postnatal therapies to optimize lung growth in CDH infants.

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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.

Congenital Diaphragmatic Hernia and Iron Defi ciency Anemia

The case described by Dr. Sarper and her colleagues in their letter to the editor, entitled “Severe iron defi ciency anemia due to late presentation of congenital diaphragmatic hernia in a toddler”, was not a late but rather a delayed diagnosis case since iron defi ciency anemia was diagnosed in this patient at least a year earlier with intermittent vomiting [1]. The diagnosis of a diaphragmatic hernia might be delayed up to at least 5 years of age as reported by us. This entity should not be extremely rare, since at least 9 patients in an 8-year period were seen by us [2]. We suggest that it should be looked for especially in very severe cases of iron defi ciency anemia with frequent vomiting. Although restricted transfusion (<7 g/dL) was recommended in adult patients with upper gastrointestinal bleeding [3], as in the authors’ patients very severe anemia (<4 g/dL) was detected in 7 of our 9 patients.

Prognose und Therapie der angeborenen Zwerchfellhernie abhängig vom Zeitpunkt der klinischen Präsentation - Erfahrungen eines hochspezialisierten Zentrums

Congenital diaphragmatic hernia (CDH) is a diagnosis with multiple, mostly unknown origin. Therefore its clinical presentation is highly variable. In case of prenatal detection prognosis and amount of interventions in neonatal intensive care is predictable. The results reported by high volume centres for CDH improved continuously during the last years. In neonates suffering from CDH without prenatal diagnosis severe respiratory distress is the leading clinical sign. Presenting symptom of late-onset CDH can also be gastrointestinal problems. Due to more subtle symptoms late presenting CDH is more difficult to diagnose. Prognosis is good, but it still requires surgical intervention to alleviate the symptoms.

Late presentation of congenital diaphragmatic Hernia after a diagnostic laparoscopic surgery (a case report)

The authors report a rare case of 17-year-old lady with late presentation of congenital diaphragmatic hernia. She presented with vague abdominal pain and was thought to have urinary tract infection, ruptured ovarian cyst, and appendicitis by different medical teams in the first few days. She eventually underwent a diagnostic laparoscopy with no significant findings. In the early postoperative recovery period, she suffered from severe cardiorespiratory distress and a large intestinal left diaphragmatic hernia was diagnosed subsequently. At further operation a strangulated loop of large bowel herniating through a left antero-lateral congenital diaphragmatic hernia was discovered, which was reduced and repaired with a prolene mesh through thoracotomy. She made an excellent recovery and was discharged a few days after the operation. The authors postulate a mechanism of positive pressure from laparoscopic surgery causing herniation of large bowel through a pre-existing diaphragmatic defect. This case highlights the diagnostic challenge of this disease due to its diverse clinical presentation, the importance of prompt diagnosis and intervention.

Congenital intrapericardial diaphragmatic hernia presenting radiologically as massive cardiomegaly

Intrapericardial diaphragmatic hernia is uncommon condition in which abdominal content herniate into the pericardium. It is mostly of traumatic origin, sometimes it is congenital. Radiologically, the condition may be suspected when the bowel loops are seen. However, diaphragmatic hernia may simulate acute gastrothorax, pneumotocelles and pneumothorax. The case of a 3-month-old infant with congenital diaphragmatic hernia in whom the bowel loops were not seen on chest radiograph and thus presented as massive cardiomegaly, is presented. The child had a successful surgery and was discharged home.

Late Presentation of Congenital Diaphragmatic Hernia: Report of Three Cases

Late Presentation of Congenital Diaphragmatic Hernia: Report of Three Cases

Late Presentation of Congenital Diaphragmatic Hernias – Report of 3 Cases

Late Presentation of Congenital Diaphragmatic Hernias – Report of 3 Cases

Gastric Volvulus Complication in an Infant With Undiagnosed Congenital Diaphragmatic Hernia Presenting With Acute Respiratory Distress

Congenital diaphragmatic hernia is an embryologic defect that creates a passage for herniation of abdominal structures into the thoracic cavity. This can lead to a variety of complications, including gastric volvulus that can present acutely with epigastric distention and vomiting. In cases of late-onset congenital diaphragmatic hernia, symptoms may be vague and often necessitate further investigation. Our patient is a 12-month-old previously healthy female infant who presented to the emergency department with a history of vomiting and acute onset respiratory distress. Her SaO(2) was 94% to 98% on room air, her respiratory rate was in the 80s breaths per minute, and she was noted to have severe retractions. Her chest examination revealed absent breath sounds on the left side. Her abdominal examination was unremarkable. The acute presentation of respiratory distress was initially concerning for a foreign body aspiration, but a chest radiograph demonstrated left-sided opacification and mediastinal shift to the right. The patient required intubation for respiratory decompensation and a subsequent computed tomographic scan showed diaphragmatic hernia with gastric volvulus. This patient's presentation highlights one of the complications that may occur owing to congenital diaphragmatic hernia. Computed tomographic scan is the confirmatory test for diaphragmatic hernia and, in this case, also uncovered a concomitant gastric volvulus. Treatment includes early resuscitation, a definitive airway, and emergent surgery to prevent ischemic necrosis of the stomach owing to strangulation, gastric perforation, and serious cardiorespiratory decompensation.