Presentation Of Congenital Diaphragmatic Hernia Research Articles

Congenital diaphragmatic hernia presenting as bowel obstruction in an infant: A case report

Congenital Diaphragmatic Hernia (CDH) is commonly diagnosed in antenatal scans or presents in the neonatal age group. Presentation of CDH in infants or older children with respiratory symptoms is less common. Similarly, the presentation of CDH with primarily gastrointestinal symptoms is also quite rare and poses a diagnostic and therapeutic challenge. An atypical case of CDH with later presentation with gastrointestinal symptoms is described. A failure to diagnose and correct it in a timely fashion could have a deleterious impact on the outcome. A case of a five-month-old child presenting with features of bowel obstruction is described. On evaluation, the child had rapidly progressive respiratory distress and gross abdominal distension, which was found to be due to left-sided CDH. A closed-loop obstruction with impending strangulation was managed with prompt surgery. The patient had a favorable outcome.Late presenting CDH may present with primarily gastrointestinal symptoms with impending respiratory compromise. A high index of suspicion is necessary to ensure early diagnosis and management.

Bochdalek hernia presenting gastrointestinal symptoms in late childhood: a case report

Most cases of congenital diaphragmatic hernia (CDH) can be diagnosed based on symptoms of severe respiratory failure during the neonatal period or fetal ultrasonography. However, some rare cases are diagnosed in late childhood or adolescence. In this case report, I describe an 11-year-old male patient diagnosed with late-onset CDH presenting with acute abdominal pain. The patient had recently experienced anorexia, nausea, and vomiting after eating. However, he reported no abdominal pain or past history of trauma. The abdomen was generally convex. All laboratory data were within normal limits. A chest X-ray revealed elevation of the left diaphragm. Chest computed tomography showed a defect in the left diaphragm. Based on the above radiologic findings, emergency surgery was performed after the diagnosis of diaphragmatic hernia. A surgical incision was performed in the left subcostal area. Finally, late-presenting Bochdalek hernia was diagnosed. The operation was completed and no specific findings on chest X-ray were found after surgery. The patient was discharged on the fourth day after surgery. In conclusion, CDH in late childhood or adolescence is rare and has various clinical manifestations. To avoid complications such as strangulation and bowel perforation, emergency surgery may be required. Thus, it is necessary to suspect CDH in children with recurrent gastrointestinal or respiratory symptoms, based on which an accurate diagnosis can be made and successful surgical treatment can be performed.

A case of congenital diaphragmatic hernia presenting in the adult as gastric volvulus

A case of congenital diaphragmatic hernia presenting in the adult as gastric volvulus

Delayed presentation of congenital diaphragmatic hernia with strangulated bowel

Congenital diaphragmatic hernia (CDH) is a frequent malformation (1 per 5000 births)(1). The diagnosis occurs frequently during prenatal assessment, however, in Brazil, it occurs in less than half of the cases (41%)(2) which may represent a bigger rate of delayed diagnosis. The relevance and challenge of this case lie in the technical difficulty in reaching the correct diagnosis in a pediatric emergency, with a late clinical presentation and doubtful imaging exams. The delay in diagnosis can lead to serious consequences. To report a case of late-presenting and complicated CDH with intestinal strangulation, explaining the surgical treatment performed and reviewing literature. Infant, male, 7 months old, presenting with vomiting, dehydration, dyspnea, and decreased breath sounds on the left hemithorax. A chest radiograph with left hemithorax opacification led to chest drainage. A chest CT suggested diaphragmatic hernia. Emergency surgery was performed due to hypovolemic shock, evidencing strangled intestinal loops herniating through a left posterolateral diaphragmatic defect. After the herniated viscera were reduced, in an attempt to avoid a near total enterectomy, it was decided to wait 12 hours and then perform a second look procedure, in which it was possible to save 1 m of small bowel. After performing the enterectomy and jejunostomy the child presented food tolerance and good evolution. The jejunostomy was closed before hospital discharge. He was clinically well after 6 months of postoperative follow-up. Late presenting CDH occurs mostly on the left (90%, bilaterality is extremely rare - less than 1%). The diagnostic of a delayed CDH is a challenge, mainly because of its varied presentations. The surgical indication depends on the patient clinical condition and, in this report, it was an emergency due to hypovolemic shock related to bowel strangulation. Late CDH should be considered in children with respiratory and/or digestive symptoms in association with suggestive imaging exams. Emergency surgery should be promptly performed if the clinical condition is associated with unresponsive hypovolemic shock.

Congenital diaphragmatic hernia presenting in adult life: a study of two cases

Congenital Diaphragmatic hernia (CDH) usually presents in the newborn and rarely present as undetected cases in adult life. Defects in the diaphragm can cause abdominal organs to herniate into the thoracic cavity resulting in respiratory distress or strangulation of abdominal organs. Reported here are 3 cases of congenital CDH presenting in adult life. A 59-year-old male presenting with epigastric pain, bilious vomiting and constipation demonstrated an air-fluid level in the anterior mediastinum on chest radiograph. Surgery revealed an anterior Morgagni defect with a loop of terminal ileum herniated and strangulated into the pericardial sac. A15-year-old girl presenting with abdominal pain and pyrexia for 2 days, on CT chest and abdomen revealed right lobe of liver and transverse colon in the right hemithorax with the pericardium pushed to the opposite side. Surgery revealed a large right sided Bochdelaks type hernia. A strangulated gangrenous transverse colon was removed from within the thoracic cavity. In these cases the body had adapted by maintaining total lung volume by compensatory hyperplasia of the contralateral lung allowing the patients to survive with no symptoms for a long duration of time. Even though rare, the possibility of CDH presenting as acute abdomen is important to remember.

Congenital Diaphragmatic Hernia presenting as recurrent respiratory tract Infections

Congenital diaphragmatic hernia is a defect in the fetal diaphragm, allowing the contents of the abdominal cavity to protrude into the thorax. It is characterized by varying degree of pulmonary hypoplasia associated with decrease in cross sectional area of pulmonary vasculature. The case report presents an incidental finding of a congenital diaphragmatic hernia at an age of two years and four months, emphasizing the increased importance of thorough clinical examination that may lead you to an important incidental diagnosis.

Late presenting Congenital Diaphragmatic Hernia Mimicking Complicated Pneumonia with? an Air Leak - A Case Report

Background: Congenital diaphragmatic hernia (CDH) is an anatomical defect of the diaphragm, which allows protrusion of abdominal viscera into the chest, causing serious pulmonary and cardiac complications in the neonate. Objective: In this case report we aimed to present a rare case of late presentation of congenital diaphragmatic hernia. Patient and method: We reported a late diagnosis of CDH at age of 3 months, who was referred to our center as a persistent left sided chest infection that needs necessarily intervention. Result: At this late-presenting patient, which could be due to small defect in the diaphragm and could be missed antenatally or even in early postnatal period, it is expected to get worse when bowel distended, or patient stressed. Management of this condition was explored in detail, survival and prognostic factors were addressed. Conclusion: CDHs are still a diagnostic challenge. Some are still missing in our community, and we need to improve medical services starting from antenatal visit. CDH should be kept in mind as a potential differential diagnosis in early infancy period for any patient presented with respiratory distress.

Diagnostic challenges in late presenting diaphragmatic hernia

Background: The incidence of congenital diaphragmatic hernia (CDH) has been reported to be 1 in 2000-5000 newborns. The late presentation can occur in 5-30% of all cases and it can be harder to diagnose, as symptoms are usually vague and non-specific. Methods: We performed a retrospective review of chart files of all patients admitted to our hospital with the diagnosis of congenital diaphragmatic hernia between 2010 and 2021. Result: Of the ninety-two cases of CDH treated in our hospital between 2010 and 2021, twenty-six (28%) were late presenting. In the late-presenting CDH group, we found a slight female preponderance, with fifteen female patients (58%) and eleven male patients. A posterolateral left defect in the diaphragm was noted in fifteen cases (58%), a right defect was noted in just one case (4%) and ten patients (38%) were diagnosed with an anterior diaphragmatic hernia. The age at diagnosis varied from 2 months to 14 years. Associated anomalies were noted in just four cases. In all cases, a thoracoabdominal radiograph was performed and ten patients also had a CT scan. Primary repair was performed in 25 of the 26 patients. The mortality rate in our study population was 11%, we reported 3 cases with unfavorable evolution. Conclusion: CDH presenting beyond the neonatal period is a usual finding and it represents a true diagnostic challenge.

Massive gastric necrosis associated with delayed presentation of congenital diaphragmatic hernia\u2014is salvage possible?

BackgroundDelayed presentation of congenital diaphragmatic hernia is an uncommon event. Occurrence of gastric volvulus with massive necrosis in this setting is unusual. In this difficult scenario, the surgeon is faced with the dilemma of conservation or resection.Case presentationA 1-year-old boy with vague gastrointestinal symptoms was found to have congenital diaphragmatic hernia with gastric volvulus, on imaging. The stomach showed massive necrosis secondary to volvulus, and after removal of the necrotic body of the stomach, the remnant was sutured together.ConclusionCongenital diaphragmatic hernia is difficult to diagnose in late presenters beyond the neonatal period due to lack of respiratory symptoms. Stomach salvage is feasible even in severe vascular compromise due to extensive collaterals.

Congenital diaphragmatic hernia presenting with symptoms within the first day of life; outcomes from a non-ECMO centre in Denmark

BackgroundBetween 1998 and 2015, we report on the survival of congenital diaphragmatic hernia (CDH)-infants presenting with symptoms within the first 24 h of life, treated at Odense University Hospital (OUH), a tertiary referral non-extracorporeal membrane oxygenation (ECMO) hospital for paediatric surgery.MethodsWe performed a retrospective cohort study of prospectively identified CDH-infants at our centre. Data from medical records and critical information systems were obtained. Baseline data included mode of delivery and infant condition. Outcome data included 24-h, 28-day, and 1 year mortality rates and management data included intensive care treatment, length of stay in the intensive care unit, time of discharge from hospital, and surgical intervention. Descriptive analyses were performed for all variables. Survivors and non-survivors were compared for baseline and treatment data.ResultsNinety-five infants were identified (44% female). Of these, 77% were left-sided hernias, 52% were diagnosed prenatally, and 6.4% had concurrent malformations. The 28-day mortality rate was 21.1%, and the 1 year mortality rate was 22.1%. Of the 21 non-survivors, nine died within the first 24 h, and 10 were sufficiently stabilised to undergo surgery. A statistically significant difference was observed between survivors and non-survivors regarding APGAR score at 1 and 5 min., prenatal diagnosis, body length at birth, and delivery at OUH.ConclusionsOur outcome results were comparable to published data from other centres, including centres using ECMO.

Thoracoscopic Repair of Congenital Diaphragmatic Hernia: a Tale from Two Cities

The prolific advances of minimal invasive surgery (MIS) have made many of the complex pediatric surgical problems amenable to these procedures for more benefits. Nowadays, successful repair of congenital diaphragmatic hernia (CDH) by thoracoscopic and laparoscopic techniques is no exception. Our study aims to highlight the surgical technique, initial results, and overview the indications of thoracoscopic repair of congenital diaphragmatic hernia (CDH). A prospective study was conducted from April 2016 to March 2018 in 2 tertiary centers in Egypt. All confirmed CDH patients were assessed for the possibility of thoracoscopic repair. Oxygenation index (OI) was used to assess the severity of persistent pulmonary hypertension (PPH). It is calculated by the following equation: MAP × FiO2 × 100 ÷ PaO2. Babies having OI < 5 are considered to have mild pulmonary hypertension; thus, thoracoscopic repair was offered for them. Thirty four CDH cases met the selection criteria; therefore, they underwent thoracoscopic repair. Group 1 included 14 late-presenting CDH patients, while 20 neonatal presenting CDH were included in group 2. Conversion to open repair occurred in 5 cases, with causes related to surgical factors, and none was due to pure anesthetic problem or general deterioration during thoracoscopy. Recurrence was discovered in 1 case only. Thoracoscopic repair of CDH is safe and feasible in treatment of late-presenting CDH. However, in neonatal CDH should the patients are assessed strictly; safety and feasibility are retained, and the conversion to open surgery is minimized.

Laparoscopic management of acute presentations of obstructed, congenital, diaphragmatic hernias in adults: case reports

: Congenital diaphragmatic hernia (CDH) occurs in 1/2,500 neonates. Hernia of Bochdalek accounts for 6%; hernia of Morgagni for 3%. Our case reports highlight the unusual, acute presentation of CDH in adults, outline diagnostic process and discuss laparoscopic techniques that can be used by surgeons faced with these rare cases. Early papers suggest presence of less than 100 reported cases of symptomatic Bochdalek and Morgagni type hernias in adults. Due to limited available evidence, the need to share successes and failures of surgical techniques used is greater than ever. Case reports here discuss successful laparoscopic techniques that can be used. Hernia of Morgagni presented in a 62 years old gentleman with acute abdominal pain and signs of obstruction on CT. Hernia of Bochdalek presented in a 50 years old lady with acute abdominal pain and vomiting, with obstruction on CT. Laparoscopically, reduction of Morgagni hernia was followed by partial reversal of hernial sac—step where controversies exist in literature. Mesh repair of defect presented challenges. Primary closure of defect was performed for Bochdalek hernia owing to its smaller size, followed by tension pneumothorax—not an uncommon occurrence. Acute, uncomplicated cases of CDH in adults can be successfully managed with emergency laparoscopic surgery. Although there is lack of standardisation currently on best surgical technique, we found good results with reduction followed by primary closure of diaphragmatic defect and use of mesh repair in case of a larger defect.

Late Presentation of Congenital Diaphragmatic Hernia with Malrotation of Midgut in Adult

Late Presentation of Congenital Diaphragmatic Hernia with Malrotation of Midgut in Adult

Late Presentation of Congenital Diaphragmatic Hernia in a 3 Month-Old Infant

A 3-month-old female infant presented with vomiting for 1-month, poor feeding and lethargy for few days with history of fever at home. On examination was noted to be lethargic, hypoxic, tachypnoeic with recessions and poor air entry and cold extremities. She was resuscitated with oxygen and fluids and was being treated for suspected sepsis. A chest X-ray (CXR) showed bowel loops in the left hemi thorax confirming the diagnosis of congenital diaphragmatic hernia (CDH). The infant was subsequently transferred to a tertiary centre where the defect was surgically corrected. This case report highlights the difficulty in suspecting and diagnosing late presenting CDH after the neonatal period.

Atypical presentation of congenital diaphragmatic hernia: case report

The Congenital diaphragmatic hernia generally presents with severe respiratory distress in the neonatal period and usually occurs once in every 2,000-3500 births. Late-presenting congenital diaphragmatic hernia (CDH) has been defined as CDH diagnosed after the neonatal period due to initial symptoms after the neonatal period or asymptomatic CDH found in the course of routine X-ray examination of the chest beyond the neonatal period. When late presentations occur, patients may be asymptomatic or may be critically ill with unusual respiratory and gastrointestinal symptoms. Case characteristics: 3yrs old female child presented with history of pain abdomen, abdominal distension, vomiting, respiratory distress and fever since 5days. Chest tube was inserted in view of left sided pleural effusion. Later on, diagnosed with diaphragmatic hernia. Outcome Child was operated, and diaphragmatic repair done and was discharged successfully after 38 days. Message: Congenital diaphragmatic hernia should be considered in the differential diagnosis of any child with unusual respiratory or gastrointestinal symptoms and abnormal chest radiographic findings.

Obstructed Bochdalek hernia: a rare presentation of congenital diaphragmatic hernia in adulthood

Congenital diaphragmatic hernia (CDH) is usually diagnosed antenatally or during the initial few hours of life in newborns who present with respiratory distress. CDH presenting with intestinal obstruction in adulthood is very rare. We report a case of 28 year old male, who presented to emergency department, with acute onset of abdominal pain and breathlessness since 2 days. Patient was investigated and diagnosed to have Bochdalek hernia (BH), with herniation of intra-abdominal contents to thorax through the defect (3.5×4.5 cms) in postero-lateral aspect of left hemi-diaphragm with obstructive features of bowel. Patient underwent emergency exploratory laparotomy with reduction of contents and hernia repair. Patient recovered and remains well. High suspicion of BH should be done when patient presents with abdominal and respiratory symptoms even though it is very rare in adults.

A Rare Association of Right-sided Congenital Diaphragmatic Hernia and Encephalocele: A Case Report

Background: This is a case report regarding a 2051-gram female newborn affected by right-sided congenital diaphragmatic hernia (CDH) presenting with encephalocele in the occipital region. Case report: The newborn was delivered by a 38-year-old mother from Darmian city, a rural district located in South Khorasan province, Iran. Conclusion: The CDH is an abnormality that rarely occurs with an approximate ratio of one in 3000 live births. It has been reported that 85% of the infants affected by this condition are left-sided and the classic posterolateral or Bochdalek hernia is the most common form. An incidence of 40%–50% has been reported regarding the other malformations associated with CDH, the most common of which are those involving the central nervous system. Some studies reported other rare associated abnormalities, including hepatopulmonary fusion, hypoplastic left heart syndrome, left heart hypoplasia, duodenal atresia, malrotation, and anorectal malformation. This case report aimed to mention encephalocele as another complication, which has not been reported for the CDH.

CONGENITAL DIAPHRAGMATIC HERNIA: LATE PRESENTATION

Late presentation of congenital diaphragmatic hernia (CDH) as an emergency is uncommon. Here, we report the case series of 3 patientswith CDH presenting to the emergency with similar complaints and had radiological features suggestive of hydropneumothorax andpleural effusion. Following emergency surgical intervention, the outcome was good. We highlight the radiological feature in CDH thatcan be misleading as it can mimic acute respiratory conditions such as pleural effusion or pneumonia.

Case Reports of Unusual Presentation of Congenital Diaphragmatic Hernia

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Diagnostic challenges in late-presenting congenital diaphragmatic hernia: a 16-year experience from tertiary care centre in North India.

With increasing use of ultrasound screening, the prenatal diagnosis of congenital diaphragmatic hernia (CDH) in better resourced areas has become the norm. However, early diagnosis is still not universal in resource-poor settings and late presentations of CDH continue. We retrospectively analysed the medical records of children operated for late-presenting CDH from 2001 to 2016 at our tertiary care centre in North India. A total of 32 patients were operated during the period with a male-to-female ratio of 3:1. Of these, 78% presented with respiratory symptoms, 37% with recurrent vomiting and 18% with an acute abdomen. Nine (28%) had been treated erroneously for gastroenteritis and another six (18%) had received anti-tubercular therapy for variable periods. A plain chest radiograph with a Ryle's tube in situ was confirmatory in 75% (24/32). In conclusion, initial misdiagnosis and subsequent unnecessary therapeutic interventions were the leading cause of morbidity .