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[Bochdalek hernia with late manifestation. Relevant clinico-surgical features]
C Baeza-Herrera1, L Velasco-Soria, L M García-Cabello
1Departamento de Cirugía General, Hospital Pediátrico Moctezuma, México, D.F.
Insights
Congenital diaphragmatic hernia (CDH) can manifest later in infancy with gastrointestinal symptoms. Bochdalek hernia, a type of CDH, requires consideration in infants presenting with non-specific digestive and respiratory issues.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Context:
- Congenital diaphragmatic hernia (CDH) typically presents in newborns.
- Delayed presentation of CDH, particularly Bochdalek hernia, can occur after the neonatal period.
- Non-specific gastrointestinal symptoms can mask respiratory distress in infants with CDH.
Purpose:
- To investigate the characteristics of congenital posterolateral (Bochdalek) hernias presenting after the newborn period.
- To identify common clinical presentations and complications in late-presenting Bochdalek hernias.
- To highlight the importance of considering Bochdalek hernia in infants with delayed-onset digestive and respiratory symptoms.
Summary:
- A retrospective study reviewed 17 pediatric patients with Bochdalek hernias presenting >10 days after birth.
- Patients experienced gastrointestinal emergencies (e.g., perforation) or a combination of vomiting, abdominal pain, and respiratory distress.
- Complications including colon and gastric perforation were noted, with a significant mortality rate.
Impact:
- Bochdalek hernias presenting post-neonatally are a significant clinical entity.
- Early recognition of digestive and respiratory signs is crucial for timely diagnosis.
- Understanding these late presentations can improve patient outcomes and reduce mortality.
Introduction:
Congenital diaphragmatic hernia presents after the first hours of life in 5 to 25% of cases. Presenting symptoms may be quite non-specific, and gastrointestinal rather than respiratory in origin. Bochdalek hernia should be considered when an infant has respiratory distress, vomiting and abdominal pain.
Material And Method:
Five-year retrospective study was made of children with congenital posterolateral (Bochdalek) hernia presenting more than 10 days after birth. The records are of 17 patients. The group was divided in two subgroups. The first, was made up of four patients who had digestive emergencies and complications such as colon and gastric perforation. One infant of this group had a left sided defect and inflammatory hepatic-pulmonary fusion. The second group was made up of 13 patients between 2 weeks and four years og age. Main complaints were vomiting, abdominal pain, and respiratory distress. Ten patients were female and 10 had a left-side defect. Herniated viscerae were small bowel, stomach, spleen, and colon. There were six deaths.
Conclusions:
Bochdalek hernia in children after the newborn period is a common entity. Frequent digestive and respiratory signs are present. Complications such as colon and gastric perforation are common.