Ghulam Rasool Tariq.
Congenital Diaphragmatic Hernia with rare associated anomalies.
Pak Armed Forces Med J Jan ;52(1):105-9.

A 2 years old male child was admitted with difficulty in breathing of 4 days duration. It was accompanied by fever, cough and vomiting. There was no H/O cyanosis. A few months ago, he remained admitted for similar complaints and was treated as a case of `Pneumonia`. There was nothing relevant in family history. There was no H/0 drug intake by the mother during pregnancy. He was delivered in the hospital and was full term. On general physical examination, the child was very restless and irritable. He had tachycardia (110/min) and tachypnoea (40/min). The temp was normal. On chest auscultation the breath sounds were absent on the left side. Heart sounds were present on the right side and borborygmi were audible in the chest. Abdomen was scaphoid. External genitalia and hernial orifices were intact. Other systems were OK clinically. Relevant investigations were carried out. X-ray chest/abdomen revealed gut loops in the left chest with scarcity of gas shadows in the abdomen. Contrast studies confirmed the diagnosis of diaphragmatic hernia. He was kept nil orally with nasogastric aspiration. After resuscitation and arranging blood he was operated upon. Left sub-costal incision was made. There was a big postero-lateral defect (app 10 cm in dia.) in the left hemidiaphragm. There was associated malrotation of the gut for which Ladds` procedure was performed. Chest intubation was done and a drain placed in the pelvis. He was discharged 2 weeks after operation.

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