A Case of Late-Onset Congenital Diaphragmatic Hernia With Suspected Intussusception and Tension Colothorax on Enterography

Abstract

Late-onset congenital diaphragmatic hernia (CDH) diagnosed after infancy often has a good prognosis but can be critical if the intestine is inlaid or strangulated. A 5-month-old girl presented with poor feeding, vomiting, and mucous and bloody stools at the time of admission. An X-ray radiograph showed an indistinct left diaphragm, but no obvious respiratory symptoms. There were no significant findings on abdominal ultrasonography, and enterography was performed for diagnostic and therapeutic purposes on suspicion of intussusception. As soon as the colon was visualized in the left thorax, rapid breathing and poor oxygenation occurred, and the patient was diagnosed as having late-onset CDH and was saved by emergency surgery. When the intestine is distended or strangulated owing to late-onset CDH, clinical symptoms are similar to those of intussusception, and if enterography is performed only for gastrointestinal symptoms, it may induce a fatal condition. If there are findings in the diaphragm, examination of other modalities should be prioritized considering the possibility of late-onset CDH.