title: Late-presenting congenital diaphragmatic hernia: diagnostic pitfalls and outcome.
abstract: OBJECTIVE
  We sought to review the presentation, diagnosis, and outcome of a series of children with late-presenting, congenital diaphragmatic hernias (CDH).
  
  
  METHODS
  Bochdalek and Morgagni hernias that were diagnosed after 30 days of age, between January 1989 and December 2009, were reviewed retrospectively. A medical record review and telephone survey were conducted in 2010.
  
  
  RESULTS
  Thirty-one subjects, diagnosed with CDH between 45 days and 13 years of age (mean, 16 months), were reviewed. Bochdalek hernias were present in 18 (58%) and Morgagni hernias in 13 (42%). There were twenty (64%) left-sided, eight (26%) right-sided, and three (10%) bilateral CDH. Five (16%) had other congenital anomalies. Eight (25.8%), including a subject with strangulated intestine that required resection, were initially misdiagnosed, due mostly to failure to obtain or correctly interpret a chest radiograph. Thirty (97%) were repaired by an abdominal approach, including seven laparoscopic closures. Follow-up ranged from 1 to 20 years (median, 7 years). All subjects survived without recurrence. Unlike neonatally diagnosed CDH, neither right-sided hernia, patch repair, nor associated esophageal atresia predicted morbidity.
  
  
  CONCLUSIONS
  Although diagnostic delays may lead to morbidity, if late-presenting CDH are expeditiously identified and repaired, their outcome is very good, in contrast to those that present in neonates.
authors.affiliation: Loma Linda University Children's Hospital, 11175 Campus St., Loma Linda, CA 92354, USA. jbaerg@llu.edu
authors.forename: J
authors.initials: J
authors.lastname: Baerg
authors.forename: V
authors.initials: V
authors.lastname: Kanthimathinathan
authors.forename: G
authors.initials: G
authors.lastname: Gollin
mesh_terms: D057210:Delayed Diagnosis; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome