Abstract
Purpose
We sought to review the presentation, diagnosis, and outcome of a series of children with late-presenting, congenital diaphragmatic hernias (CDH).
Methods
Bochdalek and Morgagni hernias that were diagnosed after 30 days of age, between January 1989 and December 2009, were reviewed retrospectively. A medical record review and telephone survey were conducted in 2010.
Results
Thirty-one subjects, diagnosed with CDH between 45 days and 13 years of age (mean, 16 months), were reviewed. Bochdalek hernias were present in 18 (58%) and Morgagni hernias in 13 (42%). There were twenty (64%) left-sided, eight (26%) right-sided, and three (10%) bilateral CDH. Five (16%) had other congenital anomalies. Eight (25.8%), including a subject with strangulated intestine that required resection, were initially misdiagnosed, due mostly to failure to obtain or correctly interpret a chest radiograph. Thirty (97%) were repaired by an abdominal approach, including seven laparoscopic closures. Follow-up ranged from 1 to 20 years (median, 7 years). All subjects survived without recurrence. Unlike neonatally diagnosed CDH, neither right-sided hernia, patch repair, nor associated esophageal atresia predicted morbidity.
Conclusion
Although diagnostic delays may lead to morbidity, if late-presenting CDH are expeditiously identified and repaired, their outcome is very good, in contrast to those that present in neonates.
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References
van den Hout L, Reiss I, Felix JF et al (2010) Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatology 98:370–380
Kitano Y, Lally KP, Lally PA (2005) Congenital diaphragmatic hernia study group. Late presenting congenital diaphragmatic hernia. J Pediatr Surg 40:1839–1843
Mei Z, Ogden CL, Flegal KM et al (2008) Comparison of the prevalence of shortness, underweight and overweight among US children aged 0 to 59 months by using CDC 2000 and the WHO growth charts. J Pediatr 153:622–628
Malone PS, Brain AJ, Kiely EM et al (1989) Congenital diaphragmatic defects that present late. Arch Dis Child 64:1542–1544
Bedoyan JK, Blackwell SC, Treadwell MC et al (2004) Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis. Outcome related variables at 2 Detroit hospitals. Pediatr Surg Int 20:170–176
Elhalaby EA, Abo Sikeem MH (2002) Delayed presentation of congenital diaphragmatic hernia. Pediatr Surg Int 18:480–485
Weber TR, Tracy T, Bailey PV et al (1991) Congenital diaphragmatic hernia beyond infancy. Am J Surg 162:643–646
Woolley MM (1977) Delayed appearance of a left posterolateral diaphragmatic hernia resulting in significant small bowel necrosis. J Pediatr Surg 12:673–674
Berman L, Stringer D, Ein SH et al (1988) The late-presenting Bochdalek hernia: a 20-year review. J Pediatr Surg 23:735–739
Osebold WR, Soper RT (1976) Congenital posterolateral diaphragmatic hernia past infancy. Am J Surg 131:748–754
Mei-Zahar M, Solomon M, Trachsel D et al (2003) Bochdalek hernia: not only a neonatal disease. Arch Dis Child 88:532–535
Wiseman NE, MacPherson RI (1977) “Acquired” congenital diaphragmatic hernia. J Pediatr Surg 12:657–665
Fisher JC, Jefferson RA, Arkovitz MS et al (2008) Redefining outcomes in right congenital diaphragmatic hernia. J Pediatr Surg 43:373–379
Hedrick HL, Crombleholme TM, Flake AW et al (2004) Right congenital diaphragmatic hernia: prenatal assessment and outcome. J Pediatr Surg 39:319–323
Valfre L, Braguglia A, Conforti A et al (2011) Long term follow-up in high-risk congenital diaphragmatic hernia survivors: patching the diaphragm affects the outcome. J Pediatr Surg 46:52–56
van Dooren M, Tibboel D, Torfs C (2005) The co-occurrence of congenital diaphragmatic hernia, esophageal atresia/tracheoesophageal fistula and lung hypoplasia. Birth Defects Res A Clin Mol Teratol 73:53
Thakral CL, Sajwani MJ (1998) Concurrent right diaphragmatic hernia and esophageal atresia. Pediatr Surg Int 14:96–97
Diamond IR, Mah K, Kim PC et al (2007) Predicting the need for fundoplication at time of congenital diaphragmatic hernia repair. J Pediatr Surg 42:1066–1070
Peetsold MG, Kneepkens CM, Heij HA et al (2010) Congenital diaphragmatic hernia: long-term risk of gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 51:448–453
Su W, Berry M, Puligandla PS et al (2007) Predictors of gastroesophageal reflux in neonates with congenital diaphragmatic hernia. J Pediatr Surg 42:1639–1643
Tsao K, Lally PA, Lally KP (2011) Congenital diaphragmatic hernia study group. Minimally invasive repair of congenital diaphragmatic hernia. J Pediatr Surg 46:1158–1164
Arca MJ, Barnhart DC, Lelli JL et al (2003) Early experience with minimally invasive repair of congenital diaphragmatic hernias: results and lessons learned. J Pediatr Surg 38:1563–1568
Peetsold MG, Huisman J, Hofman VE et al (2009) Psychological outcome and quality of life in children born with congenital diaphragmatic hernia. Arch Dis Child 94:834–840
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Baerg, J., Kanthimathinathan, V. & Gollin, G. Late-presenting congenital diaphragmatic hernia: diagnostic pitfalls and outcome. Hernia 16, 461–466 (2012). https://doi.org/10.1007/s10029-012-0906-5
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DOI: https://doi.org/10.1007/s10029-012-0906-5