Late-presenting Congenital Diaphragmatic Hernia: Case Report

Abstract

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm. It becomes evident as a result of the entrance of the abdominal organs into the chest cavity. Generally, respiratory symptoms appear in the first few hours or days of life in affected newborns. Events diagnosed after one month are considered as late-onset CDH and these constitute 5-25% of all diaphragmatic hernia cases. In late diagnosed cases, left posterolateral CDH is seen most commonly (79.4%), and 65% of patients show symptoms within one year. The most common symptom and evidence are vomiting and dyspnea. During the infancy period, respiratory complaints are seen frequently while in the older ones gastrointestinal complaints are seen more often. In this article, we present a case of a 9-year-old patient who presented with the complaint of cough only and was diagnosed with diaphragmatic hernia. The patient was admitted to our emergency department with a preliminary diagnosis of pneumonia. In the physical examination of the patient, it became evident that breath sounds were decreased in the left hemithorax. Chest X-ray showed left hemithorax opacity and suspicious intestinal appearance. The patient was diagnosed with diaphragm hernia after ultrasonograhphy and thorax tomography. The patient was transferred to the pediatric surgery department and operated. Patients with CDH may not always be diagnosed at an early stage and may come up with different clinical symptoms at different ages. It is more difficult to diagnose in late-onset cases and it is important to make differential diagnosis. This case report was presented due to rarity of late onset CDH with only complaint of cough.

Keywords

• Congenital diaphragmatic hernia
• late-presenting
• child