title: Delayed presentation of strangulated congenital diaphragmatic hernia: learning from our experience.
abstract: BACKGROUND
  Strangulation is very rare in congenital diaphragmatic hernia (CDH) of the Bochdaleck variety. Here, we share our experience with six cases of delayed presentation of strangulated CDH. The aim of this article is to provide information on how to diagnose and manage this situation using a systematic approach.
  
  
  METHODS
  A retrospective review identified six cases of strangulated/obstructed CDH from 1998 to 2011. Demographic data, clinico-radiological findings, management and complications, along with final outcome were recorded.
  
  
  RESULTS
  Small bowel gangrene was found in one patient, gastric perforation in three, transverse colon perforation in one and colonic obstruction in one patient. Video-assisted thoracoscopic surgery (VATS) was used in all but one patients for definitive diagnosis, diaphragmatic repair, pleural lavage and management of empyema. Laparotomy was needed for management of strangulated or perforated bowel. Three patients in this study survived.
  
  
  CONCLUSIONS
  Clinicians should always consider a diagnosis of obstructed Bochdaleck hernia in children, because X-ray findings are not always typical or even normal in complicated CDH. VATS may be considered as both diagnostic and therapeutic. Preventive measures for empyema or early intervention in the evolving stage can significantly reduce morbidity.
authors.affiliation: Department of Pediatric Surgery, CSM Medical University formerly King George's Medical University, Lucknow 226003, India.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Wakhlu
authors.forename: A
authors.initials: A
authors.lastname: Pandey
authors.forename: S N
authors.initials: SN
authors.lastname: Kureel
authors.forename: J D
authors.initials: JD
authors.lastname: Rawat
mesh_terms: D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005734:Gangrene / Q000209:etiology / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000209:etiology / Q000601:surgery; D013275:Stomach Rupture / Q000209:etiology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors