Congenital Diaphragmatic Hernia in the Child Beyond Infancy

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CONGENITAL hernia of the diaphragm is infrequently seen in the child beyond the age of two years, because of the frequency with which it becomes symptomatic and is treated in the neonatal period and infancy. In the newborn child and the infant, these hernial defects are life-threatening during the first hours to days of life, from collapse of the lung on the side of the defect, and compression of the contralateral lung secondary to mediastinal shift. Distention of the herniated gastrointestinal organs further exaggerates the existing respiratory insufficiency. Symptoms of severe respiratory distress, cyanosis, and dyspnea are most prominent, with circulatory disorders and gastrointestinal symptoms present to a lesser degree.

Because of the high mortality associated with congenital diaphragmatic hernia in the newborn when the defect is not promptly repaired (75 percent in the early study of Hedblom1), most of the emphasis in teaching has been placed on the symptoms of acute respiratory insufficiency seen in the newborn period. Early surgical repair of the defect is essential. A few children with small defects, however, do survive the first months and years of life without noticeable difficulty, only to have symptoms develop in later years.

In these children beyond the age of infancy, problems referable to the gastrointestinal tract usually overshadow those of the respiratory tract.2 These gastrointestinal difficulties include those of obstruction, intermittent incarceration, or, occasionally, strangulation of viscera with perforation. Such a problem is illustrated in a recent case of a congenital diaphragmatic hernia in a child of six . . .



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