CONGENITAL HERNIAS OF THE DIAPHRAGM IN CHILDREN
AbstractBackground: Congenital diaphragmatic hernia (CDH) is a major congenital malformation.Different types have been described. Bochdalek hernia (BH) remains most prevalent with highmortality rates. Other variants are less common and carry good prognosis. Although, the diagnosiscan be made antenatally, the presentation may be delayed. There is paucity of national literatureon CDHs. We present our experience with these challenging paediatric malformations.Methods: Medical records of 18 patients (£14 years) treated by the group of authors betweenOctober 1998 and April 2002 were retrospectively reviewed and demographic data, clinicalpresentation, morbidity and outcome were studied. Results: There were 13 (72%) children withBochdalek hernia, 2 (11%) with eventration of the diaphragm, 2 (11%) with hiatus hernia and1(6%) with a Morgagni hernia. The lesions were more common in girls and all the defects wereleft 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 weredocumented in 10 (77%) cases; six had multiple malformations and four died before surgery. Inother types of CDHs, the mean age at presentation was 39 (18-60) months and they mostlypresented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms.Diagnosis was made on history, physical examination, plain x -ray chest, and gastrointestinalcontrast 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 weremanaged conservatively. The overall survival rate was 67% (n=12). Conclusion: The differenttypes of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgerywas safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalekhernia.Keywords: Congenital diaphragmatic defects; Bochdalek hernia; Congenital diaphragmaticeventration; Morgagni hernia; Hiatus hernia
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