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Congenital diaphragmatic hernia presenting after the newborn period
1Department of Paediatric Surgery, University of Graz, Medical School, Austria.
Insights
Late-presenting congenital diaphragmatic hernia (CDH) is often misdiagnosed, delaying treatment. Early awareness and diagnostic imaging are crucial for timely surgical repair and improved outcomes in affected children.
Area of Science:
- Pediatric Surgery
- Medical Diagnostics
- Congenital Abnormalities
Background:
- Late-presenting congenital diaphragmatic hernia (CDH) poses diagnostic challenges.
- Delayed diagnosis is common, impacting treatment initiation.
Purpose of the Study:
- To highlight diagnostic difficulties and delays in late-presenting CDH.
- To emphasize the importance of prompt diagnosis and surgical intervention.
Main Methods:
- Retrospective review of seven pediatric patients with late-presenting Bochdaleck hernia.
- Analysis of diagnostic methods, including chest X-rays and contrast studies.
- Surgical outcomes following abdominal repair.
Main Results:
- Patients aged 1 month to 9 years presented with symptoms like feeding difficulties or respiratory infections.
- Diagnostic delays ranged from 1 week to 5 years despite initial chest X-rays.
- All patients underwent successful abdominal repair without complications, with symptom resolution.
Conclusions:
- Increased clinical suspicion for CDH is vital in children with respiratory or feeding issues.
- Careful chest film analysis and imaging techniques (contrast, ultrasound) can prevent misdiagnosis and treatment delays.
- Timely surgical closure of diaphragmatic defects leads to positive outcomes.
Abstract:
Late-presenting congenital diaphragmatic hernia (CDH) is often difficult to diagnose and delay in treatment is common. Seven patients were operated beyond the newborn period for left-sided Bochdaleck hernia. Their age ranged from 1 month to 9 years. Six of them became symptomatic within the 1st year of life (1 week to 9 months of age). Either feeding difficulties or recurrent respiratory infections were initially present. In all of them chest X-rays were performed but delay in diagnosis ranged from 1 week to 5 years. All diaphragmatic defects could be closed by an abdominal approach without postoperative complications. Clinical symptoms disappeared postoperatively. In children with respiratory complaints or feeding difficulties one should be aware of late presenting CDH. A careful analysis of chest films and searching for "connecting" bowel segments passing through the diaphragmatic defect may help to avoid incorrect diagnosis and undesirable delay in treatment. Confusion with pneumonia or pneumothorax can be diminished by placing a feeding tube and instillation of contrast material. Ultrasound should be used supportively in all suspected diseases of the diaphragm.