Background: Bochdalek hernia was first described by Czechoslovakian anatomist, Vincent Alexander Bochdalek. It is a life threatening condition with high mortality if presented in the neonatal period. Rarely, the presentation may be delayed, in which case symptomatology is different and with timely surgical intervention, prognosis is excellent. We present two cases of left Bochdalek hernia with delayed presentation in view of its rarity and pitfalls in diagnosis due to misleading symptomatology.
Case reports: Case1: 2 year old male child presented with complaints of fever of low to moderate grade and dry, non-productive cough of ten days duration. Examination of respiratory system revealed bilaterally symmetrical chest with decreased movements on left side. Breath sounds were decreased in left infrascapular, interscapular and infraaxillary regions. Chest X-ray showed congenital diaphragmatic hernia. CT scan chest, abdomen and pelvis revealed congenital diaphragmatic hernia (Bochdalek Hernia). Case 2: 1 year male child presented with history of chest retractions and on and off episodes of fever, cough, hurried breathing since 2 months of life with examination findings of severe acute malnutrition, tacyhpnea, retractions, absent air entry on left axillary and infrascapular areas with coarse crepitations. Chest x-ray showed congenital diaphragmatic hernia. Both children underwent laparoscopic repair of diaphragmatic defect and discharged safely.
Conclusion: Congenital diaphragmatic hernias are uncommon diagnosis among children due to its rarity and variable clinical features. Possibility of Bochdalek hernia with delayed presentation should always be kept in differential diagnosis of a child presenting with recurrent episodes of pneumonia or persistent respiratory signs and symptoms.
Key words: Late onset; Bochadalek; diaphragmatic hernia
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