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Late-presenting congenital diaphragmatic hernia in childhood
Pei-Hsin Chao1, Jiin-Haur Chuang, Shin-Yi Lee
1Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
Insights
Late-presenting diaphragmatic hernias in children often cause respiratory or gastrointestinal issues. Prompt diagnosis and surgical repair lead to a favorable prognosis and 100% survival in this study.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Late-presenting diaphragmatic hernias are rare congenital defects.
- Clinical presentation can be varied, mimicking other conditions.
- Associated anomalies can complicate diagnosis and management.
Purpose of the Study:
- To describe the clinical features of late-presenting Bochdalek diaphragmatic hernias.
- To evaluate diagnostic methods and patient outcomes.
- To highlight the importance of early recognition and intervention.
Main Methods:
- Retrospective review of pediatric patients (1 month-18 years) diagnosed with Bochdalek diaphragmatic hernia.
- Data collected on clinical presentation, diagnostic imaging, associated anomalies, treatment, and outcomes.
- Inclusion criteria: diagnosis of Bochdalek diaphragmatic hernia between February 1987 and June 2008.
Main Results:
- Fifteen children (median age 1.5 years) were included.
- Common symptoms included respiratory (40%), gastrointestinal (40%), or both (20%).
- Diagnosis often required advanced imaging beyond chest radiography; 100% survival was achieved with primary repair.
Conclusions:
- Late-presenting diaphragmatic hernia should be suspected in children with unexplained respiratory or GI symptoms.
- Abnormal chest radiography findings warrant further investigation.
- Accurate diagnosis and timely surgical repair are crucial for favorable outcomes.
Aim:
To characterize the clinical manifestations of late-presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes.
Methods:
The records of patients aged 1 month-18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987-June 2008 were reviewed.
Results:
Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days-9.9 years). Eleven (73%) had left-sided and four (27%) had right-sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%.
Conclusion:
Late-presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.
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