Congenital right-sided diaphragmatic hernia: a heterogeneous lesion

A clinical and radiological analysis of 13 right-sided diaphragmatic hernias is described. Four anatomically distinct though clinically similar variants (Bochdalek; paraoesophageal; eventration and Morgagni) of equal frequency make it a heterogeneous disease. Associated anomalies, found in ten out of 13 (77%), are a strong diagnostic indicator. The presence of congenital hypertrophic pyloric stenosis in 25% of infants suggests a degree of predisposition. Delay in pre-admission diagnosis was a median of 23.5 weeks from onset of symptoms and median age of diagnosis was 9 months, despite the onset of symptoms in the first week of life. A significant perinatal morbidity emphasizes the need for early diagnosis. Possible diagnostic indicators are: multiple anomalies, including chromosomal disease; an early recurrence of apparently 'cured' respiratory infection; and early onset of gastric outlet obstruction. Barium studies are the mainstay of diagnosis and were needed in ten patients. Fundoplication is a useful deterrent to recurrence in paraoesophageal hernias.