Abstract
Purpose: Among patients with congenital diaphragmatic hernia (CDH), those with late-presenting CDH (LP-CDH) have been reported to have a better prognosis. However, it has also been reported that the diagnosis is not always easy, and delayed diagnosis may sometimes be life-threatening. This study reports on LP-CDH cases experienced in an institution for 23 years.
Methods: There were 10 LP-CDH cases (11.6%) between January 1987 and December 2010. They were retrospectively reviewed and investigated on the relationship with their ages at the LP-CDH onset, presenting symptoms, the period taken for diagnosis, contents of herniated organs, presence or absence of hernia sac and their outcome.
Results: The median age at diagnosis of LP-CDH was 1 year and 4 months (76 days to 15 years). Presenting symptoms were respiratory failure in 3, digestive symptom such as abdominal pain with vomiting in 6 cases. One case had no symptoms, and was found on routine chest X-ray examination at healthy check-up. The mean period from onset to diagnosis was 4.2 days. Hernia occurred in the gastrointestinal tracts in all cases, and none had liver herniation. Nine of 10 cases were rescued without any complications, although 1 case developed cardiopulmonary arrest on the way to our hospital and died without surgical intervention.
Conclusions: Unlike neonatal cases, LP-CDH cases often occur with digestive problems and diagnosis is often delayed. It should be noted that emergent chest X-ray and insertion of nasogastric tube to decompress stomach contents should be performed as soon as possible for their rescue when LP-CDH is suspected.
