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Picture of the Month—Diagnosis
Arch Pediatr Adolesc Med. 2009;163(6):584.
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Denouement and Comment: Late Presentation of Congenital Diaphragmatic Hernia
An emergent laparotomy uncovered a smooth-edged, nontraumatic left posterolateral Bochdalek congenital diaphragmatic hernia (CDH) with the spleen, stomach, and a knuckle of the splenic flexure of the left colon up in the chest. Surgeons pulled back all of the herniated organs into the abdomen and repaired the diaphragm. No hernial sac was seen. No traumatic injuries or other anomalies were evident. The patient recovered uneventfully and was discharged 5 days postoperatively.
The CDH is an uncommon defect (1 of 2200-5000 live births) that leads to herniation of the abdominal viscera into the thoracic cavity.1 It is typically diagnosed in the immediate perinatal period, usually presenting as profound respiratory distress during the first hours to days of life.2 Late-presenting or late-onset CDH represents 5% to 25% of CDH cases.3-4 The clinical features of late-presenting CDH are nonspecific, overlap with many other pathologic manifestations, and often lead to misdiagnoses.3, 5 Symptoms include abdominal . . . [Full Text of this Article] AUTHOR INFORMATION
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Gangaram Akangire, Archana Kulkarni, Bonna Benjamin, and Jason Nirgiotis
Arch Pediatr Adolesc Med. 2009;163(6):583.
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