European Journal of Pediatrics

, Volume 152, Issue 9, pp 765–768 | Cite as

Congenital diaphragmatic hernia presenting after the newborn period

  • G. Schimpl
  • R. Fotter
  • H. Sauer
Pediatric Surgery


Late-presenting congenital diaphragmatic hernia (CDH) is often difficult to diagnose and delay in treatment is common. Seven patients were operated beyond the newborn period for left-sided Bochdaleck hernia. Their age ranged from 1 month to 9 years. Six of them became symptomatic within the 1st year of life (1 week to 9 months of age). Either feeding difficulties or recurrent respiratory infections were initially present. In all of them chest X-rays were performed but delay in diagnosis ranged from 1 week to 5 years. All diaphragmatic defects could be closed by an abdominal approach without postoperative complications. Clinical symptoms disappeared postoperatively. In children with respiratory complaints or feeding difficulties one should be aware of late presenting CDH. A careful analysis of chest films and searching for “connecting” bowel segments passing through the diaphragmatic defect may help to avoid incorrect diagnosis and undesirable delay in treatment. Confusion with pneumonia or pneumothorax can be diminished by placing a feeding tube and instillation of contrast material. Ultrasound should be used supportively in all suspected diseases of the diaphragm.

Key words

Congenital diaphragmatic hernia Late presentation 



congenital diaphragmatic hernia


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Baffes TG (1969) Diaphragmatic hernia. In: Mustard WT, Ravitch MM, Snyder WH (eds) Pediatric surgery, 2nd edn, Vol 1. Year Book Medical, Chicago, p 342Google Scholar
  2. 2.
    Berman L, Stringer D, Ein SH, Shandling B (1988) The late presenting pediatric Bochdaleck hernia: a 20-year review. J Pediatr Surg 23:735–739PubMedGoogle Scholar
  3. 3.
    Fotter R, Schimpl G, Sorantin E, Fritz K, Landler U (1992) Delayed presentation of congenital diaphragmatic hernia. Pediatr Radiol 22:187–191PubMedGoogle Scholar
  4. 4.
    Fromm SH, Luca CE (1971) An unusual complication of chronic diaphragmatic hernia in an adult patient. J Thorac Cardiovasc Surg 61:654–656PubMedGoogle Scholar
  5. 5.
    Gisanz V, Emons D, Hansmann M, Meradji M, Donaldson S, Omenaca F, Quero J, Tuck B (1986) Hydrothorax, ascites and right diaphragmatic hernia. Radiology 158:243–246PubMedGoogle Scholar
  6. 6.
    Hight DW, Hixon SD, Reed JO, Watts FB, Hertzler JH (1982) Intermittent diaphragmatic hernia of Bochdaleck: report of a case and literature review. Pediatrics 69:601–604PubMedGoogle Scholar
  7. 7.
    Hurdiss LW, Taybi H, Johnson LM (1976) Delayed appearence of left-side diaphragmatic hernia in infancy. J Pediatr 88:990–992PubMedGoogle Scholar
  8. 8.
    Kirkland JA (1959) Congenital posterolateral hernia in the adult. Br J Surg 47:16–22PubMedGoogle Scholar
  9. 9.
    Leahy PF, Liu KW, Guiney EJ (1989) Pneumothorax — An unusual delayed presentation of congenital posterolateral diaphragmatic hernia. Pediatr Surg Int 4:415–416CrossRefGoogle Scholar
  10. 10.
    Malone PS, Brain AJ, Kiely EM, Spitz L (1989) Congenital diaphragmatic defects that present late. Arch Dis Child 64: 1542–1544PubMedGoogle Scholar
  11. 11.
    Newmann BW, Afshani E, Kapp MP (1986) Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 121:813–816PubMedGoogle Scholar
  12. 12.
    Nussbaum AR, Ben-Ami T, Treves S, Teele RL (1987) Diagnosis of delayed onset right-sided congenital diaphragmatic hernia using ultrasonic and radionuclide imaging. Pediatr Surg Int 2:149–156CrossRefGoogle Scholar
  13. 13.
    Osebold RW, Soper RT (1976) Congenital posterolateral diaphragmatic hernia past infancy. Am J Surg 131:748–754CrossRefPubMedGoogle Scholar
  14. 14.
    Siegel MJ, Shackelford G, McAuster WM (1981) Left sided congenital diaphragmatic hernia: delayed presentation. AJR 137:43–46PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • G. Schimpl
    • 1
  • R. Fotter
    • 2
  • H. Sauer
    • 1
  1. 1.Department of Paediatric SurgeryUniversity of Graz, Medical SchoolGrazAustria
  2. 2.Department of RadiologyUniversity of Graz, Medical SchoolGrazAustria

Personalised recommendations