2021 Volume 57 Issue 6 Pages 992-996
We report the case of a four-year-old girl with left congenital diaphragmatic hernia (CDH) incidentally detected on left upper arm fracture. She was brought to our department owing to abnormal findings of chest X-ray that was carried out as preoperative assessment for the fracture surgery. Chest CT showed the gut, spleen, and pancreas prolapsed through the dorsal left diaphragm defect (Bochdalek) into the thoracic cavity. Upper and lower gastrointestinal series showed a jejunal to descending colon in the left thoracic cavity. In this case, a left upper arm surgery to repair dislocated fractured bones preceded a wait-and-see diaphragmatic repair. In surgery for CDH, it is difficult to return the spleen to the abdominal cavity because of a narrow hiatus causing edema of the intestinal wall and congestion of the spleen. It is important to be prepared for intraoperative accidental injury even in asymptomatic patients during radical surgery for late-presenting CDH.
