Late-Presenting Congenital Diaphragmatic Hernia in Children

• Authors: Maciej Bagłaj , Jolanta Ładogórska , Jerzy Czernik
• Languages of publication: EN

Abstracts

EN

Congenital diaphragmatic hernia (CDH) is a typical neonatal emergency. There is, however, a subset of patients who manifest this congenital anomaly in infancy and early childhood. Late-presenting diaphragmatic hernia is characterized by a variety of gastrointestinal and respiratory symptoms with acute or chronic modes of manifestation.The aim of the study. Analysis of the clinical course, diagnosis, and surgical management of latepresenting CDH in children.Material and methods. A retrospective study of medical charts and diagnostic studies was performed for children older than 1 month of age with CDH, treated in the University Department of Pediatric Surgery and Urology in Wroclaw between 1975 and 2005.Results. In a 30-year period, 23 children with late-presenting CDH were treated. In one case, paraoesophageal hernia was diagnosed; Morgagni hernia was diagnosed in 2 cases. Among 20 children with postero-lateral CDH, 12 were younger than 1 year of age at diagnosis. In this group, left-sided CHD was noted in 17 children, while a right-sided defect was noted in 3. Nine infants with left CDH presented mainly respiratory symptoms; in 3 cases gastrointestinal symptoms prevailed. In the group of children beyond 1 year of age, 6 manifested chronic respiratory symptoms and 2 had mainly acute gastrointestinal complaints. In all children, CDH was diagnosed preoperatively. The most accurate diagnostic modality in 17 cases was a contrast upper GI study. Intraoperative findings revealed the presence of a hernial sac in only 3 patients. A complicated course of CHD with torsion of the stomach was noted in 2 children; intestinal necrosis was seen in one patient. Small and large bowel were the organs most commonly displaced into the thoracic cavity (noted in 12 and 11 children, respectively). In all children, surgical management of CDH was successful.Conclusions. Lack of typical clinical signs and symptoms of late-presenting CDH seems to be a factor responsible for delayed diagnosis of this anomaly in older children. Late presentation of CDH should be taken into differential diagnosis in all children presenting with gastrointestinal or respiratory symptoms. Late-presenting diaphragmatic hernia is an unequivocal indication for surgical management as soon as its diagnosis has been established.

Keywords

EN

cogenital diaphragmatic hernia; late presentation; children

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2007
• Volume: 79
• Issue: 4
• Pages: 305-311

Dates

published

1 - 4 - 2007

online

17 - 10 - 2007

Contributors

author

Maciej Bagłaj

• Department of Pediatric Surgery and Urology, Medical University, Wrocław

author

Jolanta Ładogórska

• Department of Pediatric Surgery and Urology, Medical University, Wrocław

author

Jerzy Czernik

• Department of Pediatric Surgery and Urology, Medical University, Wrocław

References

• Butler M, Stolar C, Altman P: Contemporary management of congenital diaphragmatic hernia. World J Surg 1993; 17: 350-55.[PubMed][Crossref]
• Berman L, Stringer D, Ein S et al.: The late-presenting pediatric Bochdalek hernia: A 20-year review. J Pediatr Surg 1988; 23: 735-38.[Crossref]
• Bagłaj M: Late presenting congenital diaphragmatic hernia in children - clinical spectrum. Ped Surg Int 2004; 20: 658-69.[Crossref]
• Congenital Diaphragmatic Hernia Study Group: Late-presenting congenital diaphragmatic hernia. J Pediatr Surg 2005; 40: 1839-43.
• Newman B, Afshani E, Karp M et al.: Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 1986; 121: 813-16.[Crossref]
• Bonham Carter R, Waterston D, Aberdeen E: Hernia and eventeration of the diaphragm in childhood. Lancet I 1962; 656-59.
• Malone P, Brain A, Kiely E et al.: Congenital diaphragmatic defects that present late. Arch Dis Child 1989; 64: 1542-44.[Crossref][PubMed]
• Weber T, Tarcy T, Bailey P et al.: Congenital diaphragmatic hernia beyond infancy. Am J Surg 1991; 162: 643-46.[Crossref]
• Kirkland J: Congenital posterolateral diaphragmatic hernia in the adult. Br J Surg 1959; 47: 16-22.
• Whittaker L, Lynn H, Dawson B et al.: Hernias of the foramen of Bochdalek in children. Mayo Clin Proc 1968; 43: 580-91.
• Snyder W, Greaney E: Congenital diaphragmatic hernia; 77 consecutive cases. Surgery 1964; 57: 576-88.
• Numanoglu A, Steiner Z, Millar A et al.: Delayed presentation of congenital diaphragmatic hernia. SAJS 1997; 35: 74-76.
• Elhalaby E, Abo Sikeena M: Delayed presentation of congenital diaphragmatic hernia. Pediatr Surg Int 2002; 18: 480-85.[Crossref]
• Mei-Zahav M, Solomon M, Trachsel D et al.: Bochdalek diaphragmatic hernia : not only a neonatal disease. Arch Dis Child 2003; 88: 532-35.
• Byard R, Bohn D, Wilson G et al.: Unsuspected diaphragmatic hernia; A potential cause of sudden and unexpected death in infancy and early childhood. J Pediatr Surg 1990; 25: 1166-69.[Crossref]
• Delport S: Aftermath of failed diagnosis of latepresenting congenital diaphragmatic hernia. SAJS 1996; 34: 69-73.
• Bagłaj M, Dorobisz U: Late-presenting diaphragmatic hernia in children; a literature review. Pediat Radiol 2005; 35; 478-88.[Crossref]
• Arca M, Barnhart D, Lelli J et al.: Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 2003; 38: 1563-68.[Crossref]
• Ochoa de Castro A, Ramos M, Colange et al.: Congenital left-sided Bochdalek diaphragmatic hernia. Thoracoscopic repair-case report. Eur J Pediatr Surg 2003; 13: 407-09.
• Van der Zee D, Bax N: Laparoscopic repair of congenital diaphragmatic hernia in a 6-month-old child. Surg Endosc 1995; 9: 1001-03.[WoS]
• Becmer F, Jamali R, Moog R et al.: Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant. Surg Endoscopy 2001; 15: 1163-66.[Crossref]

Identifiers

DOI

10.2478/v10035-007-0046-2