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Late presenting congenital diaphragmatic hernia
1Paediatric Intensive Care Unit, Leicester Royal Infirmary, University Hospital of Leicester NHS Trust, Leicester, UK. srinaidu@aol.com <srinaidu@aol.com>
Insights
Delayed congenital diaphragmatic hernia can cause life-threatening tension gastrothorax in infants. Early recognition and nasogastric tube placement are crucial for managing this rare but serious condition, avoiding unnecessary procedures.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) typically presents in the neonatal period.
- Delayed presentation of CDH beyond infancy is uncommon but can lead to severe complications.
- Tension gastrothorax, a rare emergency, results from abdominal contents herniating into the chest, causing respiratory compromise.
Observation:
- A 9-month-old infant presented with acute respiratory distress.
- Chest radiography revealed a tension gastrothorax.
- Nasogastric tube placement confirmed gastric herniation into the left thoracic cavity.
Findings:
- Nasogastric tube insertion is the immediate treatment for tension gastrothorax.
- Late-presenting CDH poses diagnostic challenges, increasing the risk of misdiagnosis.
- Unnecessary invasive procedures like thoracentesis can be avoided with timely diagnosis.
Implications:
- Consider late-presenting CDH in infants with unexplained pneumothorax, particularly without trauma.
- Prompt diagnosis prevents complications and avoids potentially harmful interventions.
- This case highlights the importance of considering rare diagnoses in pediatric respiratory emergencies.
Abstract:
Delayed herniation of the abdominal contents through a congenital diaphragmatic hernia may occur beyond the neonatal period. The case is reported of a 9 month old child presenting with acute respiratory distress secondary to tension gastrothorax. The chest radiograph showed a tension gastrothorax. Nasogastric tube placement confirmed herniation of the stomach into the left chest and is the initial treatment of choice when a tension gastrothorax is identified. The late presenting congenital diaphragmatic hernia poses considerable diagnostic challenges often leading to misdiagnosis and risk of thoracocentesis. The possibility of late presenting congenital diaphragmatic hernia should be considered in unusual cases of pneumothorax, especially in the absence of trauma so that unnecessary procedures like chest tube drainage can be avoided.
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