A Case of Late-Presenting Congenital Diaphragmatic Hernia in a 14-Year-Old Girl

Abstract

A 14-year-old girl was referred to our hospital with a sudden onset of left abdominal pain during a physical education lesson. Chest-abdominal CT scans demonstrated a large amount of gastrointestinal gas in the left pleural cavity. She underwent an emergency laparoscopic surgery under the diagnosis of late-presenting congenital diaphragmatic hernia. A Bochdalek hernia was confirmed, in which the majority of the stomach, spleen, accessory spleen, splenic flexure of the colon, and greater omentum had prolapsed into the left pleural cavity through a hernial orifice measuring approximately 10 × 3 cm. The prolapsed organs were reduced, and the hernia orifice was closed completely by using interrupted sutures. Her postoperative course was uneventful and she was discharged on postoperative day 4. Late-presenting congenital diaphragmatic hernia is extremely rare because more than 95% of patients with congenital diaphragmatic hernia are newborns and most of the remainder are infants. Hernia usually occurs on the left side, in which herniation is often induced by an increased intraabdominal pressure during physical exercise, and patients with hernia present with abdominal symptoms rather than respiratory manifestations. An early diagnosis of hernia followed by an adequate surgical management is mandatory.