Abstract.
In right congenital diaphragmatic hernia (RCDH), several clinical diagnostic pitfalls are possible and should be known to those caring for infants and children with this disorder. The records of the 18 patients at Hotel Dieu de France Hospital with a history of CDH between 1990 and 1999 were collected; those of the ten who had a RCDH were reviewed retrospectively. The mean age at diagnosis was 6 months; the male-to-female ratio was 2:3. The delay between the first symptom and the diagnosis ranged between 0 and 10.5 months (mean 4.5 months). An acute presentation was observed in four cases, consisting of respiratory distress in three; the 4th presented with gastric volvulus and intestinal obstruction. The presenting symptoms were mild in four cases; recurrent respiratory infections in three and failure to thrive in one. The diagnosis was incidental in two cases during the evaluation of respiratory symptoms attributed to an atrial septal defect. The radiologic findings provided by a chest radiograph (CxR) were sufficient to make an accurate diagnosis in eight cases and peritoneography was useful in one. In six cases, the presenting CxR had been misinterpreted as normal or acute lobar pneumonia. Pathologic findings at surgery consisted of lateral and posterior right diaphragmatic defects in nine cases; the defect was lateral and anterior in one. A hernia sac was found in seven cases; malrotation was present in three. Surgical correction was done by an abdominal approach in nine cases and a thoracic approach in one. The diaphragmatic defect was repaired by transverse closure in six cases, diaphragm plication in three and prosthetic closure in one. The postoperative outcome was uneventful in eight cases. Two patients died. Thus, RCDH seems to cause less severe symptoms than left-sided LCDH. It usually manifests beyond the neonatal period as respiratory or gastrointestinal symptoms. The diagnosis should be made easily by a CxR. The presence of a hernia sac correlated with a mild presentation. An abdominal surgical approach is preferred.
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References
Berman L, Stringer D, Ein SH, Shandling B (1988) The late presenting pediatric Bochedalek hernia: a 20 year review. J Pediatr Surg 23: 735–739
Blank E, Campell JR (1976) Congenital posterolateral defect in right side of the diaphragm. Pediatrics 57: 807–810
Bonham-Carter RE, Waterston DJ, Aberdeen E (1962) Hernia and eventration of the diaphragm in childhood. Lancet 1: 656–659
Chilton HW, Chang HT, Jones MD Jr, et al (1978) Right sided congenital diaphragmatic hernia presenting as pleural effusions in the newborn: danger and pitfalls. Arch Dis Child 53: 600–603
De Lorimier AA (1994) Diaphragmatic hernia. In: Ashcraft KW, Holder TM (eds) Pediatric surgery, 2nd edn. Saunders, Philadelphia, pp 204–217
Fotter R, Schimpl J, Sorantin E, et al (1992) Delayed presentation of congenital diaphragmatic hernia. Pediatr Radiol 22: 187–191
Graviss ER, Davis RK, Lewis JE, et al (1980) Peritoneography – diagnosis of delayed onset right-sided diaphragmatic hernias masquerading as pleural effusion. J Pediatr 97: 119–122
Hartman GE (1996) Diaphragmatic hernia. In: Behrman RE, Kliegman RM, Arvin AM (eds) Textbook of pediatrics, 15th edn. Saunders, Philadelphia, pp 1161–1163
Nakayama DK, Harrison MR, Chinn DH, et al (1985) Prenatal diagnosis and natural history of the fetus with congenital diaphragmatic hernia: initial clinical experience. J Pediatr Surg 20: 118–124
Newman BM, Afshani E, Kapp MP, et al (1986) Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 121: 813–816
Numanoglu A, Sleimer Z, Millar A (1997) Delayed presentation of congenital diaphragmatic hernia. S Afr J Surg 35: 74–76
Osebold WR, Soper RT (1976) Congenital posterolateral diaphragmatic hernia past infancy. Am J Surg 131: 748–754
Rasheed K, Coughlan G, O'Donnell B (1992) Congenital diaphragmatic hernia in the newborn. Outcome in 59 consecutive cases over a ten year period (1980–1989). Ir J Med Sci 161: 16–17
Skari H, Bjornland K, Haugen G, et al (2000) Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg 35: 1187–1197
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Daher, P., Zeidan, S., Azar, E. et al. Right congenital diaphragmatic hernia a well-known pathology?. Ped Surgery Int 19, 293–295 (2003). https://doi.org/10.1007/s00383-002-0845-9
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DOI: https://doi.org/10.1007/s00383-002-0845-9