[Congenital postero-lateral right diaphragmatic hernia--case report]

There are three types of congenital diaphragmatic hernias (DH): posterolateral (Bochdalek) diaphragmatic hernia, subcostosternal (Morgagni's) hernia and esophageal hiatal hernia. The posterolateral (Bochdalek) diaphragmatic hernia is the result of a congenital diaphragmatic defect in the posterior costal part of the diaphragm in the region of 10th and 11th ribs, which allows free communication between the thoracic and abdominal cavity. The defect is usually found at the left side (90%) but may occur on the right side, where the liver often prevents detection.

We present a 9-year-old girl with persistent cough during four weeks, vomiting and loss of appetite. She was admitted in hospital after one month ambulatory treatment without success. Chest x-ray showed an infiltrative shadow in basal lobe of the right lung and multiple radiolucencies over the right hemithorax. Irrigography confirmed presence of contrast in the right hemithorax (with herniation of colon in the right lung). The child had a restrictive type of pulmonary function and was operated after establishing the diagnosis of the disease. Posterolateral diaphragmatic defect was established intraoperatively with diameter 10 x 11 cm and with ascending colon prolapse, caecum appendix and part of colon transfersum. The child was in good condition after operation. Control X-ray was normal and the child has a normal pulmonary function on routine controls.

The posterolateral right congenital DH is a rare diaphragmatic defect. The symptoms are noncharacteristic and patients with this disease can be without symptoms for a long period. The main tool for diagnosis of congenital DH is radiography, whereas treatment is surgical.