PERINATOLOGIYA I PEDIATRIYA. 2014. 2(58):30-33; doi 10.15574/PP.2014.58.30 
 

Features clinical manifestations and diagnostics late presenting congenital true diaphragmatic hernia in children 
 

Slepov O. K., Soroka V. P., Slepov Ye. O., Ponomarenko O. P. 
SE «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev, Ukraine 

Purpose: to study the clinical manifestations and to develop the diagnostic algorithm for the congenital diaphragmatic erroneous hernia among children who are older the newborn period. 

Patients and methods: there were the medical histories analyzed among 96 children age from 1 month to 15 years with different congenital diaphragmatic hernia variants during the period 1987–2013 years in the department of surgical correction of congenital malformations SI "IPOG NAMS of Ukraine". Among 16 children it was identified an erroneous congenital diaphragmatic hernia. 

Results: it was found that the very defect was mainly symptomatic. The most frequent clinical signs appeared in age from 1 month to 1 year after birth. The main clinical features of the very pathology among the different age children is a dyspnea, as a slow physical development, unsatisfactory body weight, caught, vomiting, constipation, food refusal. 

Conclusion: it was designed the diagnostic algorithm among the children with an erroneous diaphragmatic hernia that included: the radiography and fluoroscopy overview of the chest and the abdominal cavity, gastrointestinal tract x-rays researches (graphy,scopy); chest ultrasonic researches, an abdominal cavity and out spaces ( neurosonography; echocardiography); gastroduodenoscopy; the pediatrician, neurologist, ophthalmologist consulting). In hard diagnostic cases or in an differential diagnostic it is used the computer tomography, bronchoscopy, sigmoidoscopy, excretory urography, pneumoperitoneography. 

Key words: congenital true diaphragmatic hernia in children, late presenting, clinical manifestations, diagnosis, children. 

REFERENCES 
1.Juwarkar CS, Kamble DS, Sawant V. 2010. A late presenting congenital diaphragmatic hernia misdiagnosed as spontaneous pneumothorax. Indian. J. Anaesth 54 (5): 464-466.

2.Madenci AL, Sjogren AR, Treadwell MC et al. 2013. Another dimension to survival: predicting outcomes with fetal MRI versus prenatal ultrasound in patients with congenital diaphragmatic hernia. J. Pediatr Surg. 48: 1190–1197. http://dx.doi.org/10.1016/j.jpedsurg.2013.03.033

3.Bagłaj M, Dorobisz U. 2005. Late-presenting congenital diaphragmatic hernia in children: a literature review. Pediatric. Radiology. 35: 478–488. ttp://dx.doi.org/10.1007/s00247-004-1389-z

4. Bagłaj M. 2004. Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr. Surg. Int. 20 (9): 658–669. http://dx.doi.org/10.1007/s00383-004-1269-5 PMid:15349741

5. Coren ME, Rosenthal M, Bush A. 1997. Congenital diaphragmatic hernia misdiagnosed as tension pneumothorax. Pediatr. Pulmonol. 24 (2): 119–121. http://dx.doi.org/10.1002/(SICI)1099-0496(199708)24:2<119::AID-PPUL8>3.3.CO;2-Y http://dx.doi.org/10.1002/(SICI)1099-0496(199708)24:2<119::AID-PPUL8>3.0.CO;2-J

6.Vandy FC, Landrum JE, Gerig NR et al. 2008. Death due to late-presenting congenital diaphragmatic hernia in a 2-year-old child. Am. J. Forensic. Med. Pathol. 29: 75–79. http://dx.doi.org/10.1097/PAF.0b013e318165c09f PMid:19749623

7.Singh S, Bhende MS, Kinnane JM et al. 2001. Delayed presentations of congenital diaphragmatic hernia. Pediatr. Emerg. Care. 17: 269–271. http://dx.doi.org/10.1097/00006565-200108000-00013 PMid:11493830

8. Elhalaby EA, Abo Sikeena MH. 2002. Delayed presentation of congenital diaphragmatic hernia. Pediatr. Surg. Int. 18 (5–6): 480–485. http://dx.doi.org/10.1007/s00383-002-0743-1 PMid:12415386

9. Kim DJ, Chung JH. 2013. Late-presenting congenital diaphragmatic hernia in children: the experience of single institution in Korea. Yonsei Med. J. 54 (5): 1143–1148. http://dx.doi.org/10.3349/ymj.2013.54.5.1143 PMid:23918563 PMCid:PMC3743178

10. Kitano Y., Lally KP, Lally PA. 2005. Congenital Diaphragmatic Hernia Study Group. Late-presenting congenital diaphragmatic hernia. J. Pediatr. Surg. 40 (12): 1839–1843. http://dx.doi.org/10.1016/j.jpedsurg.2005.08.023 PMid:16338301

11. Delaney CA, Rozance PJ, Sandoval JA et al. 2012. Late onset diaphragmatic hernia complicated by intestinal strangulation. Curr. Opin. Pediatr. 24: 274–276. http://dx.doi.org/10.1097/MOP.0b013e3283507909 PMid:22327952 PMCid:PMC3403714

12. Chao PH, Chuang JH, Lee SY et al. 2011. Late-presenting congenital diaphragmatic hernia in childhood. Acta Paediatr. 100: 425–428. http://dx.doi.org/10.1111/j.1651-2227.2010.02025.x PMid:20874742

13. Lee HM, Addavide KE, Prince NJ. 2011. Late presentation of a diaphragmatic hernia. Arch. Dis. Child. 96: 837. http://dx.doi.org/10.1136/archdischild-2011-300287 PMid:21693506

14. Cannie M, Jani J, De Keyzer F et al. 2008. Magnetic resonance imaging of the fetal lung: a pictorial essay. Eur. Radiol. 18: 1364–1374. http://dx.doi.org/10.1007/s00330-008-0877-1 PMid:18270710

15.Gucciardo L, Deprest J, Done E et al. 2008. Prediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy. Best. Pract. Res. Clin. Obstet. Gynaecol. 22: 123–138. http://dx.doi.org/10.1016/j.bpobgyn.2007.08.006 PMid:18082455

16. Robinson PD, Fitzgerald DA, Robinson PD. 2007. Congenital diaphragmatic hernia. Paediatr. Respirat. Rev. 8: 323–335.http://dx.doi.org/10.1016/j.prrv.2007.08.004 PMid:18005901

17. Wiseman NE, MacPherson RI. 1977. "Acquired" congenital diaphragmatic hernia. J. Pediatr. Surg. 12: 657–665. http://dx.doi.org/10.1016/0022-3468(77)90389-X

18. Yap H, Jones M. 2013. Late presentation of congenital diaphragmatic Hernia after a diagnostic laparoscopic surgery (a case report). J. Cardiothorac Surg. 8. http://dx.doi.org/10.1186/1749-8090-8-8 PMid:23317447 PMCid:PMC3557185