Masuya Ryuta, Nakame Kazuhiko, Munakata Shun, Takeno Shinsuke, Nanashima Atsushi, Ieiri Satoshi
Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kiyotakecho-Kihara, Miyazaki, Miyazaki, 889-1692, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kiyotakecho-Kihara, Miyazaki, Miyazaki, 889-1692, Japan.
Surg Case Rep. 2024 Jul 30;10(1):177. doi: 10.1186/s40792-024-01980-0.
Some congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.
A 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.
We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.
一些先天性膈疝在出生1个月后才被诊断出来。迟发性先天性膈疝表现出多种临床表现，术前临床病程也各不相同。我们在此报告一例被诊断为急腹症的迟发性先天性膈疝患儿病例。
一名5岁男孩因腹痛行X线检查时发现肠道疝入左胸腔，遂被送至我院。增强计算机断层扫描显示小肠和结肠疝入左胸腔。基于左膈疝的诊断进行了急诊腹腔镜手术。整个小肠和部分结肠从膈肌后外侧缺损处疝出。我们能够将疝出的肠管回纳至腹腔，但通过腹腔镜检查证实膈肌缺损及缺损的闭合在技术上具有挑战性；因此，我们将手术转为开腹手术。用间断缝合直接关闭膈肌缺损，并对胸腔进行排气。术后发现左肺扩张不良，但该病例中未见明显的肺发育不全。
我们在此报告一例被诊断为腹痛的迟发性先天性膈疝患儿病例。迟发性先天性膈疝表现出各种各样的症状；因此，对于出现病因不明的急性或慢性呼吸道或胃肠道症状的儿童，重要的是要考虑到这些情况并检查胸部X线片。
