Pediatrics |

Diaphragmatic Hernia in 6 Months Old Infant FREE TO VIEW

Jay Ylanan, MD
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Philippine Heart Center, Quezon City, Philippines

Chest. 2015;148(4_MeetingAbstracts):778A. doi:10.1378/chest.2280626
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SESSION TITLE: Pediatrics Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: In surgical causes of respiratory distress in neonates, the underlying mechanisms include airway obstruction, pulmonary collapse or displacement and parenchymal disease or insufficiency; one of the most common causes is congenital diaphragmatic hernia (CHD). Based on the Philippine Birth Defects Registry Project in 1999-2000, CDH has 2.1 per 10,000 births. The symptoms in this late-onset group are non-specific and may commonly include recurrent chest infections, constipation and abdominal pain. For these reasons, late-presenting CDH is quite frequently misdiagnosed.

CASE PRESENTATION: The patient is a 6 months old female. She was apparently well until 3 months of age, noted with tachypnea, gurgly chest and constipation. They consulted with a local health physician and was advised to observe the patient. She was admitted in the Provincial hospital, managed as a case of Pneumonia but was transferred to a bigger hospital due to persitence of respiratory distress despite the management. Diaphragmatic Hernia was considered after Chest xray was seen by the pediatric pulmonologist. She was then referred to this institution for further management. On examination, showed decreased movement with dullness on percussion, bowel sounds on the left hemithorax and a scaphoid abdomen. Plain chest CT scan showed large hiatal hernia with mainly herniated large colon. Repair of diaphragmatic hernia was done. Chest xray after the repair of diaphragmatic hernia showed expansion of the left lung. However, this patient had Exploratory Laparotomy,segmental resection of the ileum with end to end anastomosis because of acute abdomen secondary to viscus malrotation on the 8th post-op day. Eventually, she was discharged improved with expanded left lung.

DISCUSSION: The anomaly underlying CDH is the failure of normal diaphragm development during embryogenesis. Most of the cases presenting late do not have associated anomalies, the etio-pathology of diaphragmatic defect is less likely to be similar to the usual congenital diaphragmatic hernia.1 Pneumonia is frequently the initial incorrect diagnosis in these children. Likewise, this patient was initially diagnosed as pneumonia.

CONCLUSIONS: Children presenting with tachypnea and gurgly chest should be investigated. The importance of sound physical examination, correct interpretation of imaging as surgical correction is lifesaving and curative.

Reference #1: 1. Bagłaj M. Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr Surg Int 2004 Sep;20(9):658-669.

DISCLOSURE: The following authors have nothing to disclose: Jay Ylanan

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