Late congenital diaphragmatic hernia: is a significant challenge?

Late-presenting congenital diaphragmatic hernia (L-CDH) diagnosis is a challenge for its clinical various presentation. In literature radiologic misdiagnosis is up to 62%. The aim of this study was to analyze clinical findings about our cases series in a particular setting of Pediatric Emergency Department (PED) and review of literature.

We retrospectively analyzed the medical records of children older than 1 month, operated for L-CDH from November 2009 to December 2019 presented to PED, with a total of 20 children (5 Morgagni and 15 Bochdaleck).

The median age at diagnosis was 1.48 years. Fifty per cent of the patients had a history of previous symptoms with a mean duration of 243.75 days. In 30% of cases associated anomalies were presented, mainly cardiovascular. Twenty-five per cent of patients had undergone to chest X-ray in past history with misdiagnosis of pneumonia, microganulia and broncovascular thickening. Misdiagnosis are mainly among left sided Bochdaleck hernia. Respiratory distress alone or associated with vomiting is the commonest acute symptom referred to PED. Respiratory symptoms were more common in younger children, while gastrointestinal ones in older children (not statistically differences P=0.8769). Postoperative recurrences were frequent only in cases of right sided CDH and comparing with left ones, there is a difference statistically significant (P=0.0476).

L-CDH should be suspected in cases of unexplained acute respiratory distress and vomiting, particularly when children are affected to associate cardiovascular malformation. In cases of patients with long previous symptoms and various accesses to PED is important to emphasize history of respiratory distress, dysphagia and failure to thrive and should be considered a chest X-ray.