• Ilija Kirovski Physician
  • Danilo Nonkulovski


The majority of congenital diaphragmatic hernia (CDH) are diagnosed antenatally, immediately after birth or in the neonatal period. We report case of 4-year-old child who presented with recurrent wheezing and was diagnosed to have late presenting CDH. A 4-year-old girl was admitted to the hospital with a 5-days history of increasing shortness of breath and cough. The child had normal bird history and has enjoyed relatively good health till 3 years of age. Her medical history over the last year revealed that she had 4 episodes of wheezing variously treated with inhaled bronchodilators, steroids and antibiotics. On physical examination she was in mild respiratory distress with bilateral wheezing. The x-ray showed an unusual appearance of the chest with air-filled bowel loops. A barium X-ray examination of the gastrointestinal tract confirmed the diagnosis of CDH. The hernial contents were reduced back into the abdominal cavity and surgical repair of the diaphragmatic defect was done. Late presenting CDH can be misdiagnosed and lead to delayed treatment. It should be suspected in children presenting with recurrent respiratory symptoms.  When the diagnosis is confirmed, the treatment of choice is surgical intervention. Clinical awareness, early diagnosis and operative treatment can lead to good outcomes.

Key words: Congenital diaphragmatic hernia, child, wheezing.


1. Anaya-Ayala JE, Naik-Mathuria B, Olutoye O. Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. J Pediatr Surg 2008; 43(3): 35-9.
2. Radovic S. Late presentation of congenital diaphragmatic hernia-Case report. Srp Arh Celok Lek 2015;143(9-10): 604-8.
3. Berman L, Stringer D, Ein S, Shandling B. The late presenting pediatric Bochdalek hernia: a 20-year review. J Pediatr Surg 1988; 23:735-8.
4. Weber T, Tarcy T, Bailey P, Lewis E. Congenital diaphragmatic hernia beyond infancy. Am J Surg 1991;162: 643-6.
5. Chang SW, Lee HC, Yeung CY, Chan WT, Hsu CH, Kao HA, Hung HY, Chang JH, JC Sheu, Wang NL. A twenty-year review of early and late-presenting congenital Bochdalek diaphragmatic hernia: are they different clinical spectra? Pediatr Neonatol 2010;51(1): 26-30.
6. Bagłaj M. Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr Surg Int 2004;20: 658-69.
7. Kumbhar S, Siddiqui S, Thakrar P. Avoiding misdiagnosis in postnatal presentation of congenital diaphragmatic hernia: A report of two cases and review of radiologic features. Radiol Case Rep 2019;14(10): 1288-92.
8. Yuan M, Li F, Xu C, Fan X, Yang G, Xiang B, Huang L. Emergency management of acute late-presenting congenital diaphragmatic hernia in infants and children. Pediatr Emerg Care 2021;37(7): 357-9.
9. Elhalaby E, Abo Sikeena M. Delayed presentation of congenital diaphragmatic hernia. Pediatr Surg Int 2002;18: 480-5.
10. Mei-Zahav M, Solomon M, Trachsel D, Langer J. Bochdalek diaphragmatic hernia: not only a neonatal disease. Arch Dis Child 2003;88: 532-5.
How to Cite
KIROVSKI, Ilija; NONKULOVSKI, Danilo. LATE PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA IN A 4-YEAR-OLD CHILD. Journal of Morphological Sciences, [S.l.], v. 6, n. 1, p. 132-135, may 2023. ISSN 2545-4706. Available at: <>. Date accessed: 27 feb. 2024.