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Abstract：
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：一些先天性膈疝的诊断时间超过1个月。晚期表现的先天性膈疝表现出多种临床表现，术前临床过程是可变的。我们在此报告了一例诊断为急腹症的迟发性先天性膈疝的儿科病例。
方法：一名5岁男孩因肠疝进入左胸腔而被带到我们医院，这是在腹部疼痛的X线摄影中观察到的。增强计算机断层扫描显示小肠和结肠突出进入左胸腔。根据左膈疝的诊断进行急诊腹腔镜手术。整个小肠和部分结肠从膈后外侧缺损突出。我们能够将突出的肠缩回到腹部，但证实通过腹腔镜检查，膈肌缺损和缺损的闭合似乎在技术上具有挑战性；因此，我们将手术改为开腹手术.膈肌缺损直接用断续缝线闭合,胸腔被脱气。术后,发现左肺扩张不良，但在这种情况下，肺发育不全并不明显。
结论：我们在此报告一例诊断为腹痛的迟发性先天性膈疝的儿科病例。迟发性先天性膈疝表现出各种各样的症状；因此，对于病因不明的急性或慢性呼吸道或胃肠道症状的儿童，重要的是要注意这些情况并检查胸片。
方法：一名5岁男孩因肠疝进入左胸腔而被带到我们医院，这是在腹部疼痛的X线摄影中观察到的。增强计算机断层扫描显示小肠和结肠突出进入左胸腔。根据左膈疝的诊断进行急诊腹腔镜手术。整个小肠和部分结肠从膈后外侧缺损突出。我们能够将突出的肠缩回到腹部，但证实通过腹腔镜检查，膈肌缺损和缺损的闭合似乎在技术上具有挑战性；因此，我们将手术改为开腹手术.膈肌缺损直接用断续缝线闭合,胸腔被脱气。术后,发现左肺扩张不良，但在这种情况下，肺发育不全并不明显。
结论：我们在此报告一例诊断为腹痛的迟发性先天性膈疝的儿科病例。迟发性先天性膈疝表现出各种各样的症状；因此，对于病因不明的急性或慢性呼吸道或胃肠道症状的儿童，重要的是要注意这些情况并检查胸片。
