Manipal Journal of Medical Sciences


Late presenting congenital diaphragmatic hernia (CDH) is a rare subset of diaphragmatic hernias presenting beyond 30 days of life, which may be challenging to diagnose. A 3-year-old girl was referred to our hospital with an acute history of respiratory and gastrointestinal symptoms, with a suspected diagnosis of left-sided pneumothorax. Initial radiological evidence pointed towards left hydropneumothorax. A chest X-ray and ultrasound of the chest seemed to confirm the diagnosis, hence intercostal drainage (ICD) tube was inserted. Post ICD insertion, mediastinal shift to the right was persistent and CT scan of the chest showed herniation of stomach and bowel loops into left hemithorax through a defect in the diaphragm, suggestive of late presenting CDH which was later corrected by a surgical repair. A high index of suspicion for late presenting CDH as a differential diagnosis for children presenting with varied respiratory and gastrointestinal symptoms would help in early surgical management and prevention of complications