LATE PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA – A  CASE SERIES

R. C. Datu; Olivia Stanciu; T. Enache; M. Andriescu

doi:10.33695/jss.v5i4.238

R. C. Datu ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; ”Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania
Olivia Stanciu ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; ”Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania
T. Enache ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; ”Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania
M. Andriescu ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; ”Grigore Alexandrescu” Clinical Emergency Hospital for Children, Bucharest, Romania

DOI: https://doi.org/10.33695/jss.v5i4.238

Keywords: congenital diaphragmatic hernia, late presentation

Abstract

With an incidence of 1 to 2500 to 1 to 5000 births, congenital diaphragmatic hernia (CDH) can be a life-threatening condition. In 5-25% of the cases, CDH can present at older ages with non-specific signs and symptoms. The aim of our study was to assess the clinical aspects, the diagnosis and management of the patients with this affliction as well as increase the level of awareness on late-presenting CDH. Five patients older than 1 year of age at the moment of diagnosis of CDH were included in the study. The patients presented either for respiratory symptoms or gastrointestinal one. In all the cases, during initial assess, plain chest or abdominal x-rays were performed leading to the diagnosis of congenital diaphragmatic hernia. After further imaging studies (CT scans, ultrasound) all the patients underwent surgery for defect closure, 3 of them by the classic approach, 1 by laparoscopy and 1 by thoracoscopy. Three patients had left diaphragmatic defect and 2 had an anterior diaphragmatic defect. We extensively present the case of a 14-year-old female patient with a posterolateral diaphragmatic defect, in which gastric necrosis was found during surgery, leading to partial gastric resection and esogastric anastomosis. In this case, the postoperative evolution was critical and the
patient died in the 9th day postoperatively. The evolution of the other 4 patients was uneventful.