Ref Number = PITIKA-ASPR0312
Dimas Dwi Saputro, Rifan Fauzie, Retno Widyaningsih, Alexandra
BACKGROUND. Late-presenting congenital diaphragmatic hernia (CDH) beyond the neonatal period is rare and often misdiagnosed, with delayed treatment. Late- presenting CDH incidence rate covers 5-45.5% of all cases of CDH which diagnosed after the neonatal period due to initial symptoms arise beyond the neonatal period.
OBJECTIVE. To present that a late-presenting congenital diaphragmatic hernia in children can be present as a recurrent severe pneumonia.
CASE. A 10 months old boy came to our outpatient clinic to ask for a second opinion because of recurrent pneumonia. He was treated as severe pneumonia for 2 weeks in previous hospital with a history of 7 days intubated in PICU. Then a dyspnea developed 10 days after discharged. He was observed to have tachypnea, increased work of breathing, and decreased breath sounds on the left side of the chest. On chest X-ray, he was found to have a left-sided congenital diaphragmatic hernia. There was no sign of gastrointestinal symptoms. Laboratory test revealed leucocytosis and mild anemia. Interestingly, the boy has been hospitalized for three times due to severe pneumonia and the radiographic features were not known as diaphragmatic hernia. In the operative findings, almost the entire small bowel and colon were herniated through the 4 cm posterolateral defect of the left diaphragm. Antibiotics were administered and the boy was discharged 10 days after the surgery in a well condition.
Conclusion. A high index of suspicion is important for the diagnosis of late-presenting CDH because it can be a life-threatening condition due to the comorbid symptoms. The prognosis for late-presenting CDH if diagnosed earlier is usually favourable.
Keywords: congenital diaphragmatic hernia, late-presentation, severe pneumonia
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