Right sided congenital diaphragmatic hernia

Introduction: Congenital diaphragmatic hernia is a rare affection, has been classified as posterolateral, anterior or central. The posterolateral defect occurs on the left side (85%), although it may involve the right side (13%) or be bilateral (2%). Patients and methods: We report the evolution after surgical treatment of right diaphragmatic hernia in one case. Results: A male neonate, born via uncomplicated vaginal delivery at a gestational age of 10 days, weighed 3.8 kg at birth and initially presented with weak crying and a dusky skin tone. He required intubation and was placed on a ventilator. Subsequent imaging studies including chest radiography and CT scan revealed a right congenital diaphragmatic hernia, while ultrasound confirmed the presence of pulmonary hypertension. Following stabilization, the newborn underwent thoracotomy surgery, during which intraoperative exploration revealed the entire liver within the thoracic cavity along with intestinal loops. The liver was challenging to maneuver but was successfully relocated into the abdomen, and the intestinal loops were reduced. Repair of the diaphragmatic defect was accomplished using non-absorbable sutures. Following surgery, the neonate was transferred to the neonatal intensive care unit (NICU), where a postoperative chest radiograph on the fourth day showed expansion of the right lung. Over the subsequent two years, the patient's condition remained stable without the development of respiratory complications or worsening symptoms. Conclusion: Success in this difficult case is optimized by close cooperation between the neonatologist, anesthesiologist, and pediatric surgeon. Although the hospital stay was prolonged, the survival outcome is excellent in this high-risk case.