Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 9-10, Pages: 604-608
https://doi.org/10.2298/SARH1510604R
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Late presentation of congenital diaphragmatic hernia: Case report
Radović Saša V. (Children’s Surgical Clinic, Institute for Children’s Diseases, Podgorica, Montenegro)
Introduction. Congenital diaphragmatic hernia (CDH) is a defect of the
diaphragm with the penetration of organs of the abdominal cavity into thorax.
Localization and size of the defect of the diaphragm condition the time and
range of clinical manifestation. The most common is unilateral, without
hernia sac, located on the left side, through posterolateral opening of the
diaphragm and with clinical manifestation during the neonatal period. Smaller
subgroup consists of patients with presentation outside the neonatal period
with anatomic defect on the right side as is the case with our patient. Case
Outline. Female infant aged seven months was hospitalized because of repeated
episodes of shortness of breath and cough, with lack of progress in body
weight. The discomforts had been present for the previous two months with an
inadequate response to bronchodilator and antibiotic therapy used. After
clinical, radiographic, ultrasound and computed tomography treatment, the
right-sided diaphragmatic hernia was diagnosed, so surgical treatment
followed. The defect of the diaphragm with hernia sac, through which the
right lobe of the liver with visible line of entrapment, in the form of
“hourglass”, is pushed into thoracic cavity, was intraoperatively identified.
The reposition of the right lobe of the liver in the abdominal cavity along
with reconstruction of the diaphragm using interrupted mattress sutures was
performed. Conclusion. The late manifestation of CDH should be suspected in
cases of inexplicable acute or chronic respiratory or gastrointestinal
symptoms with pathological radiography of the thorax. Accurate diagnosis and
timely minimally invasive surgical intervention ensure an excellent
prognosis.
Keywords: congenital diaphragmatic hernia, herniation, late presentation, defect of the diaphragm