Congenital hernia of diaphragma in a fourteen days-old infant :

a case report

viola1 , sri wahyuni2, catur suzantra sutisna3

1
General Practitioner 2Department of child health 3Head of department of Pediatric
Surgery
Gatot Soebroto Army Hospital, Jakarta Pusat, Indonesia

Background
Congenital Hernia of Diaphragm (CDH) is a birth defect due to abnormal formation
of the muscular parts of diaphragm. CDH occurs about 1 in 2000 to 4000 live births.
CDH is life threatening condition that may cause of due to two
complications: pulmonary hypoplasia and pulmonary hypertension.

Objective
To show that late-presenting CDH in children can be present as a recurrent severe
respiratory distress and infection.

Case
A 14 days old male infant presented to our emergency room with respiratory distress,
from physical examination we got increased work of breath and decreased breath
sound on the left side of the chest. Laboratory examination shows leukocytosis. The
antenatal ultrasound examination demonstrated normal fetal anatomy. He was
asymptomatic at birth, but admitted briefly to other hospital with recurrent respiratory
distress and respiratory infection. Intraoperative finding: 10 mm defect in the left
posterolateral diaphragm was discovered and the defect was primarily closed. Three
months after the surgery, the patient shows good response with optimal growth and
development

Figure 1. Left sided congenital diaphragmatic hernia shown in supine and

lateral chest Xray
 Figure 2. Intraoperative finding 10 mm defect in the left side diaphragm

In this case, prenatal ultrasound seems normal because left-sided CDH usually have
smaller defects that may not be detected on prenatal screening. This case illustrates
one such example and reminds providers to stay vigilant for the diagnosis of late-
presenting CDH.

Keywords : congenital hernia diaphragmatica, clinical manifestasion, respiratory

distress, respiratory infection, prenatal screening