Diagnostic and Management Challenges of Congenital Dia-phragmatic Hernia in Preterm Newborn: A Case Report in Remote Area, Asmat, South Papua

Priska Priyanka Maluenseng(1*), Kevin Pieter Toman(2), Adinda Bunga Syafina(3)


(1) Perpetua J. Safanpo General Hospital, Asmat, South Papua, Indonesia
(2) Perpetua J. Safanpo General Hospital, Asmat, South Papua, Indonesia
(3) Perpetua J. Safanpo General Hospital, Asmat, South Papua, Indonesia
(*) Corresponding Author

Abstract


Background: Congenital diaphragmatic hernia (CDH) is a rare condition associated with pulmonary complications, as the herniation of abdominal viscera into the chest can impact lung development. The majority of CDH newborns have respiratory issues at delivery or shortly after and require mechanical ventilation, which puts them at risk when they are transferred to a tertiary hospital for more extensive treatment.

Objective:This article presents a case of a preterm infant with low birth weight with CDH managed in the General Hospital, Asmat Regency.

Case Presentation:A male, born preterm at the gestational age of 31 weeks by spontaneous vaginal delivery, with a birth weight of 1505 grams. The patient had respiratory distress and required invasive ventilation shortly after delivery. When the patient showed improved oxygenation with a nasal cannula, we did a chest X-ray and detected bowel loops in the left hemithorax and mediastinal shift to the right. CDH treatment must be administered in tertiary hospitals to receive standard protocols and multidisciplinary treatment. Transferring the patient to a tertiary hospital requires continuous ventilation on full-day transportation, but the patient was not transportable; thus, we decided to operate. Significant progress was observed three months following the operation.
Conclusion: CDH requires a CT scan for definitive diagnosis, an operative procedure, and intensive treatment in a tertiary hospital. Despite the limited resources and no referral options, the patient showed clinical improvements.

Keywords


Congenital diaphragmatic hernia; remote area; preterm newborn

References


Gasparroni G, Perrotta M, Chiavaroli V, Petrucci A, Di Credico S, Cicioni P, et al. Successful lung response after surgical repair in an infant with right-sided congenital diaphragmatic hernia. Radiol Case Reports [Internet]. 2020 Sep;15(9):1502–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1930043320302727

Dangen J, Lau S, Abbas S. Treatment of a congenital diaphragmatic hernia with associated wandering spleen: Case report of a 17-year-old girl. Int J Surg Case Rep [Internet]. 2020;77:32–5. Available from: https://doi.org/10.1016/j.ijscr.2020.10.049

Britto M, Michael S, Cartaya SI, Cartaya BA. A Rare Presentation of Bilateral Bochdaleck Congenital Diaphragmatic Hernia, a Case Study. HCA Healthc J Med. 2021;2(3):181–5.

Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, et al. Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg [Internet]. 2017 Dec 18;12(1):23. Available from: https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0134-5

Jurat R, Rahimi MT. Late presenting congenital diaphragmatic hernia simulating pneumothorax. J Pediatr Surg Case Reports [Internet]. 2020 Sep;60:101561. Available from: https://doi.org/10.1016/j.epsc.2020.101561

Uinarni H, Nike F, Budianto IR, Huldani, Achmad H, Bokov DO. Newborn female with congenital diaphragmatic hernia (Bochdalek hernia): A case report. Int J Pharm Res. 2020;12(3):2138–43.

Gandhi S, Bhandarwar A, Sadhwani N, Patel C, Wagh A, Arora E. Combined laparoscopic and thoracoscopic approach for tension gastrothorax in a foramen of Bochdalek hernia. Int J Surg Case Rep [Internet]. 2019;65:141–7. Available from: https://doi.org/10.1016/j.ijscr.2019.10.076

Haro A, Kawano H, Hamatsu T, Suehiro T, Koike M, Sugimachi K. Surgical treatment of Bochodalek hernia incarcerated into the extra-pleural space: A rare case report. Int J Surg Case Rep [Internet]. 2020;73:179–82. Available from: https://doi.org/10.1016/j.ijscr.2020.07.027

Wardana OP, Utomo MT, Etika R, Handayani KD, Hariastawa IGBA, Fitriati M. Successful management of Congenital Diaphragmatic Hernia (CDH) in an 8-day-old infant with moderate persistent pulmonary hypertension, moderate muscular Ventricular Septal Defect (VSD), and small Patent Ductus Arteriosus (PDA). Bali Med J [Internet]. 2022 Sep 26;11(3):1289–92. Available from: https://balimedicaljournal.org/index.php/bmj/article/view/3468

Giuffrida M, Perrone G, Abu-Zidan F, Agnoletti V, Ansaloni L, Baiocchi GL, et al. Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper. World J Emerg Surg [Internet]. 2023 Jul 26;18(1):43. Available from: https://doi.org/10.1186/s13017-023-00510-x

Wibawanto A, Habibie YA, Arman A. Bilateral Morgagni Hernia in Infant, a Rare Type in Congenital Diaphragmatic Hernia: a Case Series. J Kedokt Syiah Kuala. 2017;17(2):93–102.

Sperling JD, Sparks TN, Berger VK, Farrell JA, Gosnell K, Keller RL, et al. Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes? Am J Perinatol. 2018;35(10):919–24.

De Barbieri Magnone F, Esparza Olave P, Ziehe Moreira L. Diagnóstico por imágenes en hernia diafragmática congénita, más que solo un defecto diafragmático: una revisión narrativa. Investig e Innovación Clínica y Quirúrgica Pediátrica. 2023;1(2):30–8.

Weems MF, Jancelewicz T, Sandhu HS. Congenital Diaphragmatic Hernia : Maximizing Survival. 2016;17(12).

Wilkinson DJ, Losty PD. Management of congenital diaphragmatic hernia. Paediatr Child Heal (United Kingdom) [Internet]. 2014;24(1):23–6. Available from: http://dx.doi.org/10.1016/j.paed.2013.07.001

Salas GL, Otaño JC, Cannizzaro CM, Mazzucchelli MT, Goldsmit GS. Congenital diaphragmatic hernia: Postnatal predictors of mortality. Arch Argent Pediatr. 2020;118(3):173–9.

Dahl MJ, Lavizzari A, Davis JW, Noble PB, Dellacà R, Pillow JJ. Impact of fetal treatments for congenital diaphragmatic hernia on lung development. Anat Rec [Internet]. 2022 Sep 5;(August):1–16. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ar.25059

Antenatal E, For T, Pulmonary DH induced, In H, Models P. EMERGING ANTENATAL THERAPIES FOR CONGENITAL. 2021;89(7):1641–9.

Antoniou SA, Pointner R, Granderath FA, Köckerling F. The Use of Biological Meshes in Diaphragmatic Defects – An Evidence-Based Review of the Literature. Front Surg. 2015;2(October):1–8.

Ng EH, Shah V. Guidelines for surfactant replacement therapy in neonates. Paediatr Child Health [Internet]. 2021 Feb 1;26(1):35–41. Available from: https://academic.oup.com/pch/article/26/1/35/6125698


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DOI: https://doi.org/10.26714/magnamed.13.1.2026.%25p

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