International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 19, October, 2014

Pages: 59-60

Date of Publication: 10-Oct-2014


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CONGENITAL DIAPHRAGMATIC HERNIA IN POST NEONATAL PERIOD

Author: Nitin Pandey, Krishna Kumar Yadav

Category: Healthcare

Abstract:Background: Late presentation of right sided congenital diaphragmatic hernia can present with recurrent cough in postneonatal period. Case characteristics: A 1 - year male child presented to outpatient with complain of recurrent cough since birth. Observation: Child was malnourished and had respiratory distress. There was no cyanosis and pallor was present. Auscultatory finding show decreased breath sound to right side and normal heart sounds. Outcome: Late presentation of right sided congenital diaphragmatic hernia. Message: CDH though, rare condition in postneonatal period could be encountered in outpatient practice with children presenting with recurrent cough and growth failure.

Keywords: Congenital diaphragmatic hernia, Post- neonatal period

Full Text:

INTRODUCTION
Congenital diaphragmatic hernia is usually suspected during neonatal period, when newborn presents with respiratory distress. Very few case reports are available in literature for its late presentation in childhood. In developing countries with limited healthcare resources, this condition could be kept in differential diagnosis in post neonatal period.

CASE REPORT
We present a case of 1 year male child presenting with recurrent cough and fever since birth. For which he had received trials of all common antibiotics and cough relieving medicine by many doctors on outpatient basis with no relief from the basic problem permanently. On examination child was in respiratory distress (Respiratory rate- 62/ min with diaphragmatic and intercostal retractions), weight 6 Kg, length 67 cm (Malnutrition according to WHO standards). Pallor was present, cyanosis absent, icterus was absent, clubbing absent and lymphadenopathy was insignificant. Temperature was 99.4 IJCRR Section: Healthcare degree F, heart reate 112/min, Blood pressure 80/54 mmHg. On auscultation there was diminished breath sound on right chest field. Cardiovascular, neurological and per abdomen examination was within normal limit. There was no suggestive history of contacts with tuberculosis. We ordered complete blood count, chest X-Ray and Mantoux test for the patient. Complete blood count was within normal limit but surprisingly in chest X- Ray we got right sided intestinal loops shadow like bag of worms and now our diagnosis was late presentation of congenital diaphragmatic hernia. Mantoux test came to be negative. After stabilizing patient condition and ruling out pulmonary hypertension in 2-D echo, we referred the patient to tertiary care center for surgical management.

DISCUSSION
Congenital diaphragmatic hernia presents with respiratory distress in neonatal period with few differential diagnosis (Anderson KD). With advances in neonatal care and resuscitation programme, congenital diaphragmatic hernia is easily diagnosed in neonatal period and managed surgically (Buttler M ). There are also sporadic case reports showing delayed presentation of CDH (craigie rj,

vandy fc, ng cp). Literature also suggests that children with right sides CDH presents with chronic symptoms in 57.4% cases, while left sided CDH mostly presents with acute symptoms, which is also the common anatomical type of CDH ( Macei Bg). In our case CDH was right sided, which is still rare in rare late presentation of CDH. Our patient’s main complain was off and on cough, which support previous finding suggesting that symptoms of respiratory system predominate the right sided CDH, while left sided CDH mainly presents with gastrointestinal symptoms (Kitano Y). Diagnosis of CDH mainly depends on clinical suspicion and chest X-Ray, although the size of herniation and amount of gastrointestinal tract herniated may cause confusion in interpretation of chest X-Ray and may confuse the picture showing differential diagnosis of pneumonia, tumor, pneumothorax and diaphragmatic eventration (Lee HM). So a quality chest x-Ray done for some other cause may diagnose a rare condition like CDH.

CONCLUSION
Congenital diaphragmatic hernia usually presents with respiratory distress in neonatal period and differential diagnosis should be considered in neonates with respiratory distress. But this condition can be missed in some neonate where respiratory distress is not so severe or proper neonatal care facility is not available. We conclude that CDH though, rare condition in postneonatal period could be encountered in outpatient practice with children presenting with recurrent cough and failure to thrive.

ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Anderson KD. Congenital diaphragmatic hernia. In: WelchK.J., Randolph JG, Ravitch MM, et al (eds.). Paediatric Surgery. Chicago, Year Book Medical 1986; 589-601.

2. Bag?aj M. Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr Surg Int. 2004 Sep;20(9):658-69.

3. Butler M, Stolar C, Altman P (1993) Contemporary management of congenital diaphragmatic hernia. World J Surg 17:350–355.

4. Craigie RJ, Mullassery D, Kenny SE. Laparoscopic repair of late presenting congenital diaphragmatic hernia. Hernia. 2007 Feb;11(1):79-82.

5. Kitano Y, Lally KP, Lally PA: Congenital Diaphragmatic Hernia study group: Late-presenting congenital diaphragmatic hernia. J Pediatr Surg 2005, 40(12):1839–1843.

6. Lee HM, Addavide KE, Prince NJ: Late presentation of a diaphragmatic hernia. Arch Dis Child 2011, 96(9):837.

7. Ng CP, Lo CB, Chung CH. Congenital diaphragmatic hernia masquerading as pneumonia. Emerg Med Australas. 2004 Apr;16(2):167-9.

8. Vandy FC, Landrum JE, Gerig NR, Prahlow JA. Death due to late-presenting congenital diaphragmatic hernia in a 2-year-old child. Am J Forensic Med Pathol. 2008 Mar;29(1):75-9.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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