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Late presentation of Bochdalek hernia: clinical and radiological aspects
H Oztürk1, I Karnak, M T Sakarya
1Department of Pediatric Surgery, Gülhane Military Medical Academy, Ankara, Turkey. hozturk@obs.gata.edu.tr
Insights
Late-presenting Bochdalek hernia in infants can mimic other conditions, leading to diagnostic delays. Early suspicion of congenital diaphragmatic hernia is crucial for timely intervention in infants with respiratory or GI symptoms.
Area of Science:
- Pediatric Surgery
- Diagnostic Radiology
- Neonatal Medicine
Background:
- Bochdalek hernia (congenital diaphragmatic hernia) often presents in neonates, but late presentations can occur.
- Late-onset symptoms may include respiratory distress (dyspnea, cyanosis) and gastrointestinal issues (vomiting).
Observation:
- Three infants with late-presenting Bochdalek hernia are described.
- Initial diagnoses were varied, including paravertebral mass or aspiration, based on initial imaging and history.
- Symptoms included cough, intermittent vomiting, dyspnea, and cyanosis.
Findings:
- Advanced imaging (CT, MRI, contrast studies) was essential for diagnosing Bochdalek hernia.
- Hernias were located on the left (2) and right (1) sides.
- Herniated contents included stomach, intestines, spleen, and colon.
Implications:
- Congenital diaphragmatic hernia should be considered in infants with unexplained respiratory or GI symptoms and abnormal chest X-rays.
- Varied radiological findings necessitate high clinical suspicion to avoid misdiagnosis and treatment delays.
- Prompt diagnosis and surgical repair are vital for improved infant outcomes.
Abstract:
Three infants with late presentation of Bochdalek hernia are presented. The presenting symptoms were cough, intermittent vomiting, dyspnea, and cyanosis. Initial diagnoses of isolated paravertebral mass and foreign material aspiration were made in two infants, based on plain chest x-ray findings and history of the patients. Further radiological investigations, such as contrast upper gastrointestinal series or enema, computerized tomography, and magnetic resonance imaging of the chest, suggested the diagnosis of Bochdalek hernia. The hernia was found on the left side in two patients and on the right side in one. At operation, the stomach, small intestine, and spleen were found as herniated organs in one patient, ascending colon in one, and all of the small intestine together with ascending colon in the other. A congenital diaphragmatic defect should be suspected in every child presenting with unusual respiratory or gastrointestinal symptoms and with abnormal chest x-ray findings. The radiological findings vary greatly from one case to another, and even in the same case at different times because of differences in herniated organs and intermittent spontaneous reduction. The possibility of congenital diaphragmatic hernia should be kept in mind to avoid a wrong diagnosis, undue delay in diagnosis, and inappropriate treatment.