Muhammad Afzal, Mahmood Shaukat, Muhammad Saleem, Muhammad Afzal Sheikh.
Delayed presentation of congenital diaphragmatic hernia (bochdalek type).
Pak J Med Health Sci Jan ;4(4):396-400.

Objective: To document various clinical manifestations of Bochdalek congenital diaphragmatic hernia presenting late and identify reasons of late presentation. Place and duration of study: The department of pediatric surgery, The Children’s Hospital and The Institute of Child Health, Lahore, from July 2001 to July 2005. Patients and methods: 40 children with Bochdalek congenital diaphragmatic hernia (CDH) who presented after one month of age were studied. Detailed history, examination and results of required investigations were recorded. Data was processed regarding manifestations, reasons for late diagnosis and outcome of these cases. Results: 45 children with Bochdalek type of CDH met the inclusion criteria. Three main modes of presentation were observed. Thirty five (77.78%) children presented with respiratory symptoms, nine (20%) had gastrointestinal symptoms and one (2.2%) patient manifested combined symptoms. Diagnosis was made on chest x-ray (68.88%), chest ultrasound (11.11%), upper GIT barium contrast study (15.56%) and chest CT scan (4.45%). Four (8.89%) patients died preoperatively. Surgical complications included wound infection in two (4.88%), burst abdomen in four (9.75%), adhesion obstruction in two (4.88%) and recurrence of hernia in two (4.88%) patients. Four patients died postoperatively. The overall prognosis was favorable. Conclusion: Delayed CDH has a variable presentation. Early diagnosis can be made if it is included in the differential diagnosis of recurrent chest infection and gastrointestinal tract symptoms. Chest radiograph with nasogastric tube and chest ultrasound in suspected cases are useful tools to prevent delay in final diagnosis.

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