Congenital diaphragmatic hernias in children older than 1 month of life: features of clinical course and diagnostics, treatment tactics
DOI:
https://doi.org/10.15574/PS.2026.1(90).6775Keywords:
children, congenital diaphragmatic hernia, Bochdalek hernia, Morgagni hernia, diagnosis, diagnostic algorithm, treatment strategyAbstract
Aim - to analyze the clinical features and diagnostic outcomes of congenital diaphragmatic hernias (CDH) detected after the neonatal period and to develop a diagnostic algorithm for them.
Materials and methods. A retrospective review of medical records was conducted for 27 children aged 1.5 months to 13 years with late-diagnosed CDH who were treated at the Department of Pediatric Surgery.The study analyzed the patients’ age and sex, the type and location of the hernia, clinical manifestations, associated congenital anomalies, and the results of diagnostic and therapeutic procedures. For diagnosis, X-ray, ultrasound, and endoscopic methods were used, as well as computed tomography and magnetic resonance imaging when indicated. Statistical analysis of the results was performed using descriptive statistics.
Results. Late-diagnosed CDH were identified in 27 (15.9%) of 170 children with CDH, specifically Bochdalek’s hernia in 21 (77.8%) patients and Morgagni’s hernia in 6 (22.2%). Clinical manifestations were varied and nonspecific, with respiratory and gastrointestinal symptoms — or a combination thereof — predominating. The primary diagnostic method was plain radiography of the chest and abdomen in two projections. When X-rays were insufficiently informative, contrast-enhanced X-ray studies, ultrasound, computed tomography, or magnetic resonance imaging were used. Based on the results obtained, a diagnostic algorithm for late-detected CDH was developed.
Conclusions. Late-diagnosed CDH are characterized by a polymorphic clinical picture, which often leads to a delay in diagnosis. The primary diagnostic method is a chest and abdominal X-ray in two projections, while additional imaging methods are used as indicated to confirm the diagnosis and plan surgical intervention. The proposed diagnostic algorithm makes it possible to optimize the evaluation of children with suspected CDH, shorten the time to diagnosis, and timely determine the indications for surgical treatment.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the parents or legal guardians of the children participating in the study.
The authors declare no conflict of interest.
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