Late-presenting Congenital Diaphragmatic Hernia Research Articles

Late-presenting congenital diaphragmatic hernia: A Bochdalek hernia diagnosis in a six-week-old with respiratory symptoms

Late-presenting congenital diaphragmatic hernia: A Bochdalek hernia diagnosis in a six-week-old with respiratory symptoms

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen

BackgroundSome congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.Case presentationA 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.ConclusionsWe herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.

A Rare Case of a Late Onset Central Tendon Diaphragmatic Hernia

A congenital diaphragmatic hernia (CDH) is a rare condition which usually presents in the first few days of life. In older children and adults however, the diagnosis may be more difficult. Late-presenting CDH is less common and the majority present with non-specific gastrointestinal or respiratory symptoms later in childhood. For these reasons, late-presenting CDH is quite frequently misdiagnosed. Most CDH are of the Bochdalek or posterolateral type with much smaller numbers of anterior or Morgagni defects. We present a case report of this rare type of CDH in an older child and our experience managing the condition. The purpose of this report is to familiarize clinicians and surgeons with the clinical presentations that can occur in children with CDH, in order to facilitate early management and avoid possible life-threatening conditions.

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.

Late-presenting congenital diaphragmatic hernia associated with poor weight gain.

Late-presenting congenital diaphragmatic hernia associated with poor weight gain.

A Case of Late Presenting Congenital Diaphragmatic Hernia-Anaesthetic Management

Late presenting Congenital Diaphragmatic hernia beyond the neonatal period though rare, mostly misdiagnosed, mistreated and end up in life threatening complications. CDH can occur at any older age and usually present as mild respiratory symptoms to as severe as gastric obstruction or acute obstructive respiratory problems. Perhaps the error at reaching a definitive diagnosis is simply because of the fact, the possibility of CDH at an older age is totally neglected.

Late congenital diaphragmatic hernia: is a significant challenge? A case series and review from literature.

Late-presenting congenital diaphragmatic hernia (L-CDH) diagnosis is a challenge for its clinical various presentation. In literature radiologic misdiagnosis is up to 62%. The aim of this study is analyze clinical findings about our cases series in a particular setting of Pediatric Emergency Department (PED) and review of literature. We retrospectively analyzed the medical records of children older than 1 month, operated for L-CDH from November 2009 to December 2019 presented to PED, with a total of 20 children (5 Morgagni and 15 Bochdaleck). The median age at diagnosis was 1,48 years. 50% patients had a history of previouses symtptoms with a mean duration of 243,75 days. In 30 % of cases associated anomalies were presented, mainly cardiovascular. 25% of patients had undergone to chest X-ray in past history with misdiagnosis of pneumonia, microganulia and broncovascular thickening. Misdiagnosis are manly among left sided Bochdaleck hernia. Respiratory distress alone or associated with vomiting is commonest acute symptom refered to PED. Respiratory symptoms were more common in younger children, while gastrointestinal ones in older children (not statistically differences p=0,8769). Post-operative recurrence were frequent only in cases of right sided CDH and comparing with left ones, there is a difference statistically significant (p=0.0476). L-CDH should be suspected in cases of unexplained acute respiratory distress and vomiting, particulary when children are affected to associate cardiovascular malformation. In cases of patients with long previouses symptoms and various accesses to PED is important to emphasize history of respiratory distress, dysphagia and failure to thrive and should be considered a chest X-ray.

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.

Pitfalls and Solutions in Endoscopic Surgery for Late-Presenting Congenital Diaphragmatic Hernia

Pitfalls and Solutions in Endoscopic Surgery for Late-Presenting Congenital Diaphragmatic Hernia

Which Is the Better Approach for Late-Presenting Congenital Diaphragmatic Hernia: Laparoscopic or Thoracoscopic? A Single Institution's Experience of more than 10 Years.

Aim: We evaluated a series of late-presenting congenital diaphragmatic hernia (Late-CDH) cases and assessed the reliability and risks of laparoscopic and thoracoscopic approaches for Late-CDH at a single institution. Materials and Methods: From 2005 to 2017, we experienced totally 11 patients with Late-CDH who received endoscopic repairs. We retrospectively surveyed the approach, defect size, operating time, and postoperative outcomes, including recurrence. Results: Eleven patients (Bochdalek, n = 10; Morgagni, n = 1) underwent a total of 14 endoscopic repairs (laparoscopy, n = 10; thoracoscopy, n = 4). The average defect size was ∼3.1 × 1.5 cm. In all 14 endoscopic repairs, patients received intracorporeal interrupted nonabsorbable stitches and extracorporeal knot tying were applied, without the use of an artificial patch. In the laparoscopic repairs, 7 patients received left-handed suturing when closing the diaphragmatic defect, because the reduced viscera lay directly below the posterior rim of the diaphragmatic defect, making it difficult to confirm the rim. In contrast, in the thoracoscopic repairs, the viscera were reduced over the diaphragmatic defect, so the surgeons could easily perform suturing. The average operating time was 172 minutes for laparoscopy and 194 minutes for thoracoscopy. No major intraoperative or postoperative complications occurred in association with either of the approaches. Among the 11 patients, 2 experienced a total of 3 recurrences (all after laparoscopic repairs). Conclusion: Although there were few differences between the laparoscopic and thoracoscopic approaches, because of the technical difficulty of the procedure and the possibility of recurrence with the laparoscopic approach, a thoracoscopic approach may be better for the repair of Late-CDH.

Morgagni-Larrey parasternal diaphragmatic hernia masquerading as pleural effusion: an interesting presentation with review of literature

Congenital diaphragmatic hernia (CDH) is a major malformation found in newborns and babies but rarely in adults. CDH is defined by the presence of a defect in the diaphragm, which permits the herniation of abdominal contents into the thorax. The diagnosis of CDH is based on clinical history, examinations and is confirmed by plain X-ray films and computed tomography scans. Here we report a case which was misdiagnosed at another centre as pleural effusion and managed by placement of intercostal tube drainage and later on diagnosed to be case of Morgnani-Larrey parasternal diaphragmatic hernia. Congenital diaphragmatic hernia (CDH) is a major malformation found in newborns and babies but rarely in adults. CDH is defined by the presence of a defect in the diaphragm, which permits the herniation of abdominal contents into the thorax. The diagnosis of CDH is based on clinical history, examinations and is confirmed by plain X-ray films and computed tomography scans. The purpose of reporting this case is to provide information on late-presenting CDH and to emphasize that a high index of suspicion is required for diagnosis and to avoid unwanted complications.

Congenital Diaphragmatic Hernia (Bochkdalek)—Becomes Symptomatic in Seventh Decade of Life—a Rare Case Report

Congenital diaphragmatic hernia (CDH) is a condition characterized by defect in the diaphragm which leads to protrusion of abdominal contents or viscera into the thoracic cavity interfering with normal development of the lungs. CDH is a developmental defect of diaphragm associated with significant neonatal mortality and morbidity. Incomplete development of diaphragm allows the abdominal content to invade the thoracic cavity resulting in compression of the developing lungs. Most of the CDH diagnosed in the new born or early childhood. Around 1% with CDH have no symptoms and may be detected incidentally. Diaphragmatic hernias can be divided into two broad categories: congenital and acquired. A congenital diaphragmatic hernia (CDH) occurs through embryologic defects in the diaphragm, and most patients present early in life rather than later. However, a subset of adults may present with a smaller CDH that was undetected during childhood. Infants with CDH often present in the neonatal period with severe respiratory distress. Early surgery is mainstay of treatment in newborn as mortality is very high in this condition. Here, we are describing very late presentation of a case of congenital diaphragmatic hernia treated by surgery with good post operative outcome. This case report summarizes how to diagnose and manage a late-presenting congenital diaphragmatic hernia to prevent further complications.

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.

Diagnostic Considerations of Late Presenting Congenital Diaphragmatic Hernia in Children: Single Center Experience

Diagnostic Considerations of Late Presenting Congenital Diaphragmatic Hernia in Children: Single Center Experience

Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Komarowska M, Matuszczak E, Baran M, Dzienis-Koronkiewicz E, Hermanowicz A, Dębek W. Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature. Pediatria Polska - Polish Journal of Paediatrics. 2020;95(1):44-47. doi:10.5114/polp.2020.94928. APA Komarowska, M., Matuszczak, E., Baran, M., Dzienis-Koronkiewicz, E., Hermanowicz, A., & Dębek, W. (2020). Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature. Pediatria Polska - Polish Journal of Paediatrics, 95(1), 44-47. https://doi.org/10.5114/polp.2020.94928 Chicago Komarowska, Marta, Ewa Matuszczak, Marcin Baran, Ewa Dzienis-Koronkiewicz, Adam Hermanowicz, and Wojciech Dębek. 2020. "Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature". Pediatria Polska - Polish Journal of Paediatrics 95 (1): 44-47. doi:10.5114/polp.2020.94928. Harvard Komarowska, M., Matuszczak, E., Baran, M., Dzienis-Koronkiewicz, E., Hermanowicz, A., and Dębek, W. (2020). Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature. Pediatria Polska - Polish Journal of Paediatrics, 95(1), pp.44-47. https://doi.org/10.5114/polp.2020.94928 MLA Komarowska, Marta et al. "Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature." Pediatria Polska - Polish Journal of Paediatrics, vol. 95, no. 1, 2020, pp. 44-47. doi:10.5114/polp.2020.94928. Vancouver Komarowska M, Matuszczak E, Baran M, Dzienis-Koronkiewicz E, Hermanowicz A, Dębek W. Late-presenting congenital diaphragmatic hernia in an infant with tuberous sclerosis – case report and a review of the literature. Pediatria Polska - Polish Journal of Paediatrics. 2020;95(1):44-47. doi:10.5114/polp.2020.94928.

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.

Emergency Management of Acute Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.

ObjectivesAcute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.MethodsA retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted.ResultsA total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition.ConclusionsAcute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.