Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum

Abstract

Articles dealing with late-presenting congenital diaphragmatic hernia (CDH) in children published until 2003 were collectively reviewed. The main purpose of the presented study was to gain insight into the clinical spectrum of this variant of CDH and to discuss its clinical and surgical aspects. In 125 articles, 362 patients were reported. Left posterolateral hernia was the dominant anatomical type, found in 79.4% of the children. Male-to-female distribution was nearly 2:1 in both right- and left-sided CDH. Associated anomalies were noted in 8.6% of children. Sixty-five percent of children with right CDH presented within the 1st year of life, whereas only 41.7% of patients with left CDH belonged to this age group. The children with right CDH presented with chronic symptoms in 57.4% of cases, while among those with left CDH, acute presentation prevailed, constituting 60.5% of this group. No strict correlation between age and clinical symptoms was noted, although the youngest patients tended to present with respiratory symptoms. Late-presenting diaphragmatic hernia is associated with a wide range of clinical symptoms occurring in various constellations. Dyspnea and vomiting were the most frequent symptoms found in patients with either chronic or acute manifestation. Preoperative mortality was 3.9% (14 children). In 45 children (12.4%), complications resulting from diaphragmatic hernia were noted, and in a further 11 children iatrogenic preoperative complications were noted. Among 152 children with reported CDH, true hernia with sac was found in 32.7%. Eight children (2.2%) died in the early postoperative period, while a further 13 patients (3.6%) had postoperative complications requiring surgical management. Recurrence of hernia was noted in seven children (1.9%). This collective review of basic epidemiological and clinical data from a large group of patients seems to support a hypothesis for a congenital nature of the diaphragmatic defect and an acquired nature of "herniation" of the viscera. The wide clinical spectrum of late-presenting CDH seems to be conditioned by two factors: timing of herniation and type of intraabdominal viscera displaced into the chest.

A Rare Cause of Haemorrhage in the Upper Gastrointestinal System Bochdalek Hernia

“…Recurrent pulmonary infections, dyspnoea, wheezing, chest pain, recurrent abdominal pain, dysphagia, lack of appetite, nausea, vomiting and diarrhoea have been reported in the literature. Gastrointestinal haemorrhage and anaemia may develop as a result of diaphragmatic hernia-related gastric volvulus (4,5,8,9). Gastric volvulus-related upper gastrointestinal haemorrhage was present in our case.…”

“…There is a high risk of complications in large hernias with abdominal organs. Surgical treatment should be considered in these cases (5,11,12). Emergency surgery was performed in our case.…”

“…Emergency CT can be performed when accompanying pathologies are suspected and when the intestinal loops are strangulated. Direct abdominal radiography can be important in the diagnosis of patients with vomiting of uncertain cause (4,5,8,10,11). Indeed, we learned from her history that she had been monitored for three days in another centre because of vomiting.…”

“…The reason for delayed treatment of Bochdalek hernia given late findings is difficulty of diagnosis. Clinical findings in Bochdalek hernia producing late findings are generally associated with the respiratory and gastrointestinal systems (4)(5)(6).…”

Late-Onset Congenital Diaphragmatic Hernia; Report of Three Cases

“…En sık (%79,4) sol posterolateral KDH görüldüğü, hastaların %65'inin ilk bir yıl içerisinde semptom verdiği rapor edilmiştir. En sık gözlenen semptom kusma ve dispnedir (9). Geç başlangıçlı hastalarda süt çocukluğu döneminde solunum sistemi yakınmaları ön planda iken, daha büyük çocuklarda gastrointestinal sistem yakınmaları ön plandadır (10).…”