Delayed presentation of congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is a well-documented disease entity at birth; still it challenges today's pediatric physicians and surgeons. Some CDH do not present clinically at birth; delays in diagnosis happen in infancy, teenage or even in adulthood. From January 1961 to December 1991, nine consecutive patients were collected with delayed presentation of CDH. Their mean ages were 30 years (ranging from 6 months to 68 years); the male/female ratio was 5/4. Four had Bochdalek's hernia, four had miscellaneous diaphragmatic hernia and one, Morgagni's hernia. The later the presentation occurred, the milder the symptoms. Barium study was the best diagnostic tool if the hernia contents included bowel loops. However, solid organ herniation still remained a challenge in diagnosis before surgery. It is recommended that laparotomy is the choice for infant patients in order to examine the associated bowel anomaly, while thoracotomy is a proper approach for more adult patients, but the incision should be made via a lower intercostal incision than that for lobectomy. However, if preoperative diagnosis of Morgagni's hernia can be made, exploratory laparotomy is a favorite approach. For patients with delayed presentation of CDH, surgical repair is indicated to prevent the possible risk of bowel obstruction and strangulation. The surgical result is generally satisfactory.