A Rare Case of Late Presentation of Congenital Diaphragmatic Hernia (original) (raw)

Late presentation of congenital diaphragmatic hernia

PubMed, 2015

Late presentation of congenital diaphragmatic hernia is 5-30% of all congenital diaphragma hernia cases. It can present as Morgagni, Bochdalek and paraesophageal hernia. Misdiagnosis can result in significant morbiditiy. A 17-month-old girl presented with vomiting and abdominal pain. On physical examination, circulatory disturbance, cyanosis, abdominal distantion were present. Her O2 saturation was 60% and she was tachycardic (180 bpm) and tachypneic (58 bpm) with hypotension (60/35 mmhg). Patient's heart and mediastinum were shifted into the right hemithorax on the chest X-ray. Bowel loops in the left hemithorax with air-fluid levels were seen in her plain X-ray and diaphragmatic hernia was seen in her computed tomography examination. She was referred to our center and operated within an hour. Herniated intestinal loops and stomach were observed from about 2 cm diameter defect of diaphragma were repaired primarily. She was extubated in postoperative 4th day. Late presentation of congenital diaphragmatic hernia may be confused with many situation and is difficult to diagnose without clinical suspicion. Accurate diagnosis and urgent treatment is lifesaving.

Congenital Diaphragmatic Hernia Associated With Uncommon Abnormalities

International Archives of Medicine, 2017

Congenital diaphragmatic hernia is a poor formation of the diaphragm characterized by the presence of an intestinal malrotation, It is related to abnormal position of the intestine in the thorax. This case report a stillborn at 32 weeks, that was observe anatomical abnormalities associated with congenital diaphragmatic hernia, which occurred in the left antero-posterior region, such as intestinal malrotation, hepatomegaly and nephromegaly, with the presence of a hernial ring that occupied 80 % of the left side of the diaphragm, besides a hypertrophied heart, deviated to the right, bilateral pulmonary hypotrophy. This case illustrates a rare case of diaphragmatic hernia with intestinal changes of clinical and surgical importance.

Natural history of a complex congenital diaphragmatic hernia

Romanian Medical Journal

The main complication in the case of congenital diaphragmatic hernia (CDH), which results from the invasion of the abdominal viscera in the thoracic cavity, is represented by the insufficient development of the pulmonary parenchyma (pulmonary hypoplasia, with the increase of the vascular resistance, and finally pulmonary hypertension). Besides pulmonary hypertension, the fetus can also develop cardiac failure in various degrees. Usually, this occurs when the arterial canal closes. We present a completely prenatal diagnosed case of left diaphragmatic hernia of the stomach, liver, and intestinal loops associated with left pulmonary agenesis and stenosis of arterial duct. The important right shifting of the heart in the right hemithorax detected on second trimester ultrasound screening has complicated in the third trimester with pericarditis, pleurisy and heart failure. The magnetic resonance imaging (MRI) examination at 31 weeks of gestation confirmed the ultrasound findings and offer...

Late-onset congenital diaphragmatic hernia: A case report

International Journal of Surgery Case Reports, 2013

INTRODUCTION: A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiafragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. PRESENTATION OF CASE: In this paper we present a 35 year old man with a 5-year history of episodes of severe dyspnea who arrived to the emergency room, during his medical work-up we incidentally found an intrathoracic gastric bubble, a laparoscopy was performed, founding a necrotic stomach and for defect correction. DISCUSSION: This pathology is infrequent in adults, among this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. CONCLUSION: Diaphragmatic hernias are rare among adult population, and they are usually asymptomatic, in this case we presented a symptomatic patient, diagnosed with a chest X-ray and treated surgically. The surgical approach for the resolution of this pathology is variable and it depends on the presence and severity of visceral complications.

Congenital asymptomatic diaphragmatic hernias in adults: a case series

Journal of Medical Case Reports, 2013

Introduction: Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. Case presentations: In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemithorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here.

Congenital diaphragmatic hernia: a case report

The Medical journal of Malaysia, 1973

The article is a case report of a 20 years old pregnant woman that, at her first obstetrical exam, at 29 weeks of gestation was diagnosed with CDH with severe left side lung hypoplasia, mediastinal shift on the right side and a compressed right lung. At 39 weeks of gestation, by caesarian section, a 3300 grams female baby was born with an APGAR score of 8. The reconstructive surgery, thanks to a stable fetal status on mechanical ventilator, could be made 2 days later and it revealed a rare case of Bochdalek CDH in a pleuroperitoneal membrane and multiple accessory spleen. After 3 days of good postoperative status an episode of severe dyspnea revealed a rare complication, a postoperative hiatal hernia with the whole stomach into the thorax. A second successful reconstructive surgery was made in emergency and the baby was discharged 2 weeks later. CDH remains one of the most challenging topics of perinatology and neonatal surgery. Its mechanisms are still to be unveiled but the severe lesions, especially of the lungs require the full implication of a mixt team of highly skilled doctors, in order to increase the very low survival rate (around 40 percent in most studies). This, together with the very low incidence (1 CDH in every 2500 births) and a 10 percent incidence of Bochdalek CDH with sac in all CDH cases, make the background of a solid-base protocols of management extremely difficult. Therefore this should be a hot topic for researchers in the future.

Right congenital diaphragmatic hernia: an 18-year experience

Journal of Pediatric Surgery, 2007

Background: Prenatal diagnosis and outcome of right congenital diaphragmatic hernia (RCDH) are far less well known than the more common left CDH (LCDH). In addition, onset of RCDH beyond the neonatal period with a spectrum of atypical symptoms is not unusual. A retrospective analysis of RCDH treated at a single center over 18 years has been reviewed with regard to outcome after the introduction of a new treatment protocol for CDH. Methods: All charts of patients with CDH between 1987 and 2004 were reviewed. Twenty-nine patients with RCDH were identified. The patients were divided into 2 historical groups: group 1, from 1987 to 1998 (16 patients), and group 2, from 1999 to 2004 (13 patients). From 1999, at the Department of Pediatric Surgery of Padua, the management of a baby born with CDH has been standardized and includes planned delivery at term, high-frequency oscillatory ventilation since birth, inhaled nitric oxide if required, extracorporeal membrane oxygenation as a blast resort,Q and delayed repair once the infant is hemodynamically stable. Patients with either prenatal diagnosis of RCDH or early onset of symptoms (b6 hours of life) were considered bhigh risk,Q and those with late onset (N6 hours) were considered blow risk.Q Results: Of 29 patients, prenatal diagnosis was available in 8 (27.5%) and major associated malformations in 8 patients (27.5%). Eight (50%) of 16 cases from group 1 and 9 (69.2%) of 13 cases from group 2 were high-risk patients. There was a trend in favor of a higher survival among high-risk patients from group 2 (25% vs 44%), although this was not statistically significant. As expected, all lowrisk patients survived ( P = .0001). Plain thorax x-ray was diagnostic in 23 (82.1%) cases, initially normal in 3, not performed in 1, and misinterpreted as right lower lobe pneumonia in 2. At operation, the prosthetic patch was required in 2 (9%) of 22 cases and the peritoneal sac was found in 4 (13.7%). Conclusions: (1) The rate of prenatal diagnosis of RCDH was low and remained stable throughout the examined period. (2) The introduction of a treatment protocol, using high-frequency oscillatory ventilation since birth, improved the survival of high-risk patients with RCDH, although the data did not reach statistical significance. (3) The majority (75%) of low-risk patients presented beyond the first week of life with a variety of aspecific gastrointestinal or respiratory symptoms that accounted for initial misdiagnosis. (4) Even in these cases, the outcome was excellent. D

CONGENITAL DIAPHRAGMATIC HERNIA: GENERAL OVERVIEW AND MEDICAL INTERVENTIONS (Atena Editora)

CONGENITAL DIAPHRAGMATIC HERNIA: GENERAL OVERVIEW AND MEDICAL INTERVENTIONS (Atena Editora), 2023

The present article is a systematic review of the literature using PubMed and LILACS databases. 10 articles were selected that were in accordance with the proposal. Congenital diaphragmatic hernia (CDH) is characterized by the absence or failure of the diaphragm to close after 10 weeks of gestation, an age at which it must already have its formation process complete and without defects. Its etiology is still poorly understood, but it is presumed to be multifactorial. This communication between cavities allows abdominal organs to move into the chest, putting pressure on the lungs and preventing their proper development. The main consequences of CDH are variable degrees of hypoplasia and pulmonary hypertension, gastroesophageal reflux and intestinal obstruction, leading to high morbidity and mortality. For early diagnosis and effective management of cases, it is essential to identify and study diagnostic methods, such as ultrasound and magnetic resonance imaging; of the main pre (Endoluminal Tracheal Occlusion or “FETO”) and postnatal (Extracorporeal Membrane Oxygenation or “ECMO”) medical interventions, in addition to current protocols for oxygenation and pH management after birth.