Late-presenting congenital diaphragmatic hernia in childhood.
OBJECTIVE
To characterize the clinical manifestations of late-presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes.


METHODS
The records of patients aged 1 month-18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987-June 2008 were reviewed.


RESULTS
Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days-9.9 years). Eleven (73%) had left-sided and four (27%) had right-sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%.


CONCLUSIONS
Late-presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.
Chao
Pei-Hsin
PH
Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
Chuang
Jiin-Haur
JH
Lee
Shin-Yi
SY
Huang
Hsin-Chun
HC
D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012120:Respiration Disorders / Q000209:etiology; D013997:Time Factors