Diagnostic challenges in late-presenting congenital diaphragmatic hernia: a 16-year experience from tertiary care...

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Medical Diagnostics

Background:

• Prenatal diagnosis of congenital diaphragmatic hernia (CDH) is standard in well-resourced regions.
• Early diagnosis remains a challenge in resource-limited settings, leading to late presentations.
• Late-presenting CDH cases often experience diagnostic delays and inappropriate initial treatments.

Purpose of the Study:

• To analyze the clinical characteristics and outcomes of children operated for late-presenting CDH.
• To identify factors contributing to delayed diagnosis and morbidity in resource-poor settings.
• To evaluate diagnostic methods for late-presenting CDH.

Main Methods:

• Retrospective analysis of medical records of 32 children operated for late-presenting CDH between 2001 and 2016.
• Review of presenting symptoms, initial diagnoses, treatments, and diagnostic modalities.
• Assessment of diagnostic accuracy of plain chest radiography with a Ryle's tube.

Main Results:

• 32 patients (male:female ratio 3:1) underwent surgery for late-presenting CDH.
• Common presentations included respiratory symptoms (78%), recurrent vomiting (37%), and acute abdomen (18%).
• Significant misdiagnosis occurred, with 28% treated for gastroenteritis and 18% for tuberculosis; plain chest radiography was diagnostic in 75%.

Conclusions:

• Initial misdiagnosis and delayed interventions are significant causes of morbidity in late-presenting CDH.
• Improved diagnostic strategies and awareness are crucial for timely management in resource-limited areas.
• Plain chest radiography with a Ryle's tube is an effective diagnostic tool for late-presenting CDH.