Diaphragmatic Hernia in a Pediatric Emergency Department

Abstract

Diaphragmatic hernia in pediatric emergency department poses a diagnostic challenge because of the acute or subtle timing of onset and the wide variety of clinical features. We describe 3 different late presentations of Bochdalek diaphragmatic hernia in a pediatric emergency department. These reports may help physicians avoid delayed diagnosis of late-presenting congenital diaphragmatic hernia, thereby reducing the risk of inappropriate treatments and life-threatening conditions in children.

Congenital diaphragmatic hernia: an unusual presentation

“…3 In some cases, initial radiographic findings have been misinterpreted as being caused by a pneumothorax or pleural effusion and chest tubes have been inappropriately placed. 4,6,7 It is helpful to place a nasogastric tube, as it will appear within the thoracic cavity, deviated from its expected location, supporting the diagnosis. 3,4,6,7 Computed tomography imaging is recommended to confirm the diagnosis and assess possible complications.…”

“…4,6,7 It is helpful to place a nasogastric tube, as it will appear within the thoracic cavity, deviated from its expected location, supporting the diagnosis. 3,4,6,7 Computed tomography imaging is recommended to confirm the diagnosis and assess possible complications. 4,5,7 Patients with neonatal presentation frequently face significant mortality and long-term morbidity with respiratory, nutritional, musculoskeletal, and neurodevelopmental problems, as well as possible hernia recurrence.…”

“…Clinically these cases may present acutely or insidiously with recurrent/ intermittent symptoms. 6,7 The clinical picture may include gastrointestinal complaints (such as abdominal pain, vomiting and/or constipation), respiratory distress, chronic cough, recurrent respiratory infections, failure to thrive or even being assintomatic. 2,3,5,7 Due to its diverse presentation, diagnosis is challenging and a high index of suspicion is necessary.…”

“…6,7 The clinical picture may include gastrointestinal complaints (such as abdominal pain, vomiting and/or constipation), respiratory distress, chronic cough, recurrent respiratory infections, failure to thrive or even being assintomatic. 2,3,5,7 Due to its diverse presentation, diagnosis is challenging and a high index of suspicion is necessary. 4,5 Similar to the case presented, herniation may be intermittent, and the presence of a previous normal chest radiography does not exclude the diagnosis.…”

“…3,4,6,7 Computed tomography imaging is recommended to confirm the diagnosis and assess possible complications. 4,5,7 Patients with neonatal presentation frequently face significant mortality and long-term morbidity with respiratory, nutritional, musculoskeletal, and neurodevelopmental problems, as well as possible hernia recurrence. [1][2][3] The outcome is worse when associated anomalies coexist, so long-term follow-up by a multidisciplinary team is recommended.…”