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[Late revealing of congenital diaphragmatic hernia: diagnostic difficulties]
1Service de pédiatrie A, centre hospitalier et universitaire de Caen, France.
Insights
Delayed presentation of congenital diaphragmatic hernias in infants is possible, but surgical repair leads to favorable long-term outcomes with minimal complications. This highlights the importance of timely diagnosis and intervention for congenital diaphragmatic hernias.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect.
- Late presentation of CDH outside the neonatal period is less common but occurs.
- Early diagnosis and intervention are crucial for managing CDH.
Observation:
- Two pediatric cases of CDH presenting at 4 and 6 months of age are described.
- Clinical symptoms included progressive respiratory failure.
- Radiographic findings revealed left lung consolidation, pneumothorax, and ascites.
Findings:
- Herniated bowel segments were observed passing through the diaphragmatic defect in all cases.
- Surgical repair was successfully performed using an abdominal approach for both patients.
- Despite delayed presentation, the long-term prognosis was favorable.
Implications:
- This case report underscores that delayed presentation of CDH does not preclude positive surgical outcomes.
- Minimizing the time delay between symptom onset and surgical repair is important.
- Pediatric surgeons and neonatologists should consider CDH in infants presenting with respiratory distress, even beyond the neonatal period.
Abstract:
Two patients, aged four and six months, with congenital diaphragmatic hernias, and who presented outside of the neonatal period, are reported. Clinical presentation was a progressive respiratory failure, and radiographic findings showed a consolidation of the left lung, associated with a pneumothorax in one and an ascites in the other. One had previous normal chest X-rays. All cases with herniated bowel showed connecting bowel segments passing through the diaphragmatic defect. All were repaired via an abdominal approach. Delay in presentation of congenital diaphragmatic hernias is not uncommon. Long-term prognosis is favourable and postoperative morbidity is minimal, despite late presentation and undesirable time delay between first sign and surgery.