Parkash Mandhan, Aslam Memon, A Sattar Memon


Background: Congenital diaphragmatic hernia (CDH) is a major congenital malformation.
Different types have been described. Bochdalek hernia (BH) remains most prevalent with high
mortality rates. Other variants are less common and carry good prognosis. Although, the diagnosis
can be made antenatally, the presentation may be delayed. There is paucity of national literature
on CDHs. We present our experience with these challenging paediatric malformations.
Methods: Medical records of 18 patients (£14 years) treated by the group of authors between
October 1998 and April 2002 were retrospectively reviewed and demographic data, clinical
presentation, morbidity and outcome were studied. Results: There were 13 (72%) children with
Bochdalek hernia, 2 (11%) with eventration of the diaphragm, 2 (11%) with hiatus hernia and
1(6%) with a Morgagni hernia. The lesions were more common in girls and all the defects were
left sided. The average age at the time of presentation of BH was 23 hours (2 to 72 hours)
commonly presenting with cyanosis and respiratory distress. Associated anomalies were
documented in 10 (77%) cases; six had multiple malformations and four died before surgery. In
other types of CDHs, the mean age at presentation was 39 (18-60) months and they mostly
presented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms.
Diagnosis was made on history, physical examination, plain x -ray chest, and gastrointestinal
contrast study, when required. 14 (78%) children were operated and a sac was present in 5.
Post-operative complications occurred in 5 (55%) patients with Bochdalek hernia, which were
managed conservatively. The overall survival rate was 67% (n=12). Conclusion: The different
types of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgery
was safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalek
Keywords: Congenital diaphragmatic defects; Bochdalek hernia; Congenital diaphragmatic
eventration; Morgagni hernia; Hiatus hernia

Full Text:



Doyle NM, Lally KP. The CDH Study Group and advances in

the clinical care of the patient with congenital diaphragmatic

hernia. Semin Perinatol 2004;28(3):174-84.

Graham G, Devine PC. Antenatal diagnosis of congenital

diaphragmatic hernia. Semin Perinatol 2005; 29(2):69-76.

Robnett-Filly B, Goldstein RB, Sampior D, Hom M. Morgagni

hernia: a rare form of congenital diaphragmatic hernia. J

Ultrasound Med 2003; 22:537-9.

Chacko J, Ford WD, Furness ME. Antenatal detection of hiatus

hernia. Pediatr Surg Int 1998; 13(2-3):163-4.

Elhalaby EA, Abo Sikeena MH. Delayed presentation of

congenital diaphragmatic hernia. Pediatr Surg Int 2002; 18(5-


Clark RH, Hardin WD Jr., Hirschl RB, Jaksic T, Lally KP,

Langham MR Jr, et al. Current surgical management of

congenital diaphragmatic hernia: a report from the Congenital

Diaphragmatic Hernia Study Group.

J Pediatr Surg 1998;33(7):1004-9.

Smith CD, Sade RM, Crawford FA, Othersen HB,

Diaphragmatic paralysis and eventration in infants. J Thorac

Cardiovasc Surg 1986; 91(4):490-7.

Jawad AJ, al-Sammarai AY, al-Rabeeah A. Eventration of the

diaphragm in children. J R Coll Surg Edinb 1991;36:222-24.

Greenholz SK. Congenital diaphragmatic hernia: an overview.

Semin Pediatr Surg 1996; 5:216-23.

Vanamo K. A 45-year perspective of congenital diaphragmatic

hernia. Br J Surg 1996; 83:1758-62.

Puri P, Gorman WA. Natural history of congenital

diaphragmatic hernia: implications for management. Pediatr

Surg Int 1987; 2:327-30.

Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital

diaphragmatic hernia-a tale of two cities: the Boston

experience. J Pediatr Surg 1997; 32:401-5.

Pokorny WJ, McGill CW, Harberg FJ. Morgagni hernias during

infancy: presentation and associated anomalies. J Pediatr Surg

; 19:394-7.

Al-Salem AH, Nawaz A, Matta H, Jacobsz A . Herniation

through the foramen of Morgagni: early diagnosis and

treatment. Pediatr Surg Int 2002; 18:93-7.

Swain JM, Klaus A, Achem SR, Hinder RA. Congenital

diaphragmatic hernia in adults. Semin Laparosc Surg 2001;


Crankson SJ, Al Jadaan SA, Namshan MA, Al-Rabeeah AA,

Oda O. The immediate and long-term outcomes of newborns

with congenital diaphragmatic hernia. Pediatr Surg Int 2006;


Arca MJ, Barnhart DC, Lelli JL, Greenfeld J, Harmon CM,

Hirschl RB, et al. Early experience with minimally invasive

repair of congenital diaphragmatic hernias: results and lessons

learned. J Pediatr Surg 2003; 38:1563-68.

de Lorimier AA. Diaphragmatic Hernia. In: Pediatric Surgery,

Ashcraft KW, Holder TM, editors, Philadelphia: WB Saunders;

pp. 204-17

Smith HL. Gastro-oesophageal reflux and hiatal hernia in

children. N Z Med J 1980; 92:148-151.

Sakai H, Tamura M, Hosokawa Y, Bryan AC, Barker GA,

Bohn DJ. Effect of surgical repair on respiratory mechanics in

congenital diaphragmatic hernia. J Pediatr 1987; 111:432-38.

Taskin M, Zengin K, Unal E, Eren D, Korman U. Laparoscopic

repair of congenital diaphragmatic hernias. Surg Endosc 2002;


Rothenberg SS, Chang JH, Bealer JF. Experience with

minimally invasive surgery in infants. Am J Surg 1998;


Kimmelstiel FM, Holgersen LO, Hilfer C. Retrosternal

(Morgagni) hernia with small bowel obstruction secondary to a

Richter's incarceration. J Pediatr Surg 1987; 22:998-1000.

Mishalany HG, Nakada K, Woolley MM. Congenital

diaphragmatic hernias: eleven years' experience. Arch Surg

; 114:1118-1123.

Harrison MR, Adzick NS, Estes JM, Howell LJ. A prospective

study of the outcome for fetuses with diaphragmatic hernia.

JAMA 1994; 271:382-384.

Mirza A, Mansoor SH. Congenital Diaphragmatic Hernia:

Don’t haste Surgery. Ann King Edward Med Coll 1997;


Jaillard SM, Pierrat V, Dubois A, Truffert P, Lequien P, Wurtz

AJ, et al. Outcome at 2 years of infants with congenital

diaphragmatic hernia: a population-based study. Ann Thorac

Surg 2003; 75:250-6.

Muratore CS, Kharasch V, Lund DP, Sheils C, Friedman S,

Brown C, et al. Pulmonary morbidity in 100 survivors of

congenital diaphragmatic hernia monitored in a

multidisciplinary clinic. J Pediatr Surg 2001; 36:133-40.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] []