A 2-year-old girl suddenly vomited and complained of abdominal pain. A chest and abdominal X-ray showed air and air-fluid level in her left thoracic cavity, leading to incorrected diagnosis of left tension pneumothorax. She was transported to our hospital. Pneumothorax could not be ruled out by X-ray, but respiratory symptoms were poor. Computed tomography (CT) and upper gastrointestinal series indicated her as congenital diaphragmatic hernia (CDH) and gastric dilatation due to gastric volvulus. During her emergency surgery, the intraoperative findings showed the prolapse of the stomach, transverse colon and spleen into the left thoracic cavity through the defect of the left-posteolateral diaphragm. The late-presenting CDH is considered that many cases are mild cases, and prognosis is considered to be good. But the symptoms are various, therefore it is difficult to perform accurate-initial treatment and preoperative diagnosis of this disease.
Watanabe et al. (Wed,) studied this question.