Congenital diaphragmatic hernia with late manifestation: case report

Abstract

Introduction: congenital diaphragmatic herniation is characterized by incomplete diaphragm formation and neonatal incidence is about 1:3,000 to 1:5,000 liveborns. Almost ninety percent of the patients present respiratory dysfunction in the first twenty-four hours of life. Objective: to emphasize the importance of early diagnosis, established primarily during prenatal care, for the appropriate therapeutic management. Case description: a five-month-old infant was admitted to the emergency of a hospital located in the Agreste region of Pernambuco with sudden dyspnea, irritability, and moans; chest radiography demonstrated left bronchial dilation, which sugges ted foreign body aspiration. The child was transferred to a Reference Hospital to perform bronchoscopy, being admitted with a severe general condition, significant respiratory discomfort and a drop in oxygen saturation. The medical team urgently requested a chest tomography, which suggested diaphragmatic herniation. The patient was then submitted to videothoracoscopy for the surgical correction of congenital malformation. The patient had an evident improvement in respiratory discomfort after the procedure, being discharged on the third postoperative day. Discussion: congenital diaphragmatic
herniation with late manifestation may have a variable clinical presentation, which hinders its prompt diagnosis and increases the chances of complications. For differential diagnosis, imaging tests become important, especially contrast radiography and chest tomography, since they complement the study of a less common condition.