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Delayed presentation of congenital diaphragmatic hernia
R Fotter1, G Schimpl, E Sorantin
1Department of Radiology, University Hospital Graz, Austria.
Insights
Delayed diagnosis of congenital diaphragmatic hernias in children can lead to severe complications. Increased awareness of atypical symptoms is crucial for timely intervention in pediatric cases.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Congenital diaphragmatic hernia (CDH) typically presents in neonates.
- Delayed presentation of CDH outside the neonatal period is less common but recognized.
Observation:
- Eight pediatric patients (1 month to 9 years) with CDH presented beyond the neonatal period.
- Radiographic findings varied, mimicking lung disease or pneumothorax; one Morgagni hernia was initially missed.
- Herniated bowel segments were consistently observed traversing the diaphragmatic defect.
Findings:
- Lack of awareness regarding delayed CDH presentation contributed to diagnostic delays.
- Time from initial X-ray to surgery ranged up to 16 months in four patients.
- Delayed diagnosis can result in life-threatening complications.
Implications:
- Highlights the importance of considering CDH in children with uncharacteristic thoracic or abdominal symptoms.
- Emphasizes the need for improved diagnostic awareness and protocols for delayed CDH presentations.
- Underscores the potential for severe outcomes due to delayed surgical intervention in pediatric CDH.
Abstract:
Eight patients aged 1 month up to nine years with congenital diaphragmatic hernias (seven left sided postero-lateral, one right-sided antero-medial), who presented outside of the neonatal period, are reported, four are described in detail. Radiographic presentation was obvious in four patients, simulated inflammatory lung disease in one and pneumothorax in two. In one patient a Morgagni hernia was primarily missed. Two had previous normal chest X-rays. All cases with herniated bowel showed "connecting" bowel segments passing through the diaphragmatic defect. Primarily the lack of awareness of delayed presentation of congenital diaphragmatic hernia in children with uncharacteristic thoracic and/or abdominal symptoms led to an undesirable time delay between first chest X-ray and surgery up to 16 months in four of our cases. Life threatening complications can be the consequence of delayed diagnosis as in one of our cases.