Congenital diaphragmatic hernia (CDH) is herniation of bowels and abdominal solid organs in thoracic cavity, causing pulmonary hypoplasia with decreased pulmonary vasculature and dysfunction of the surfactant system. In severe cases, left ventricular hypoplasia us also observed. Delayed herniation the abdominal contents through a congenital diaphragmatic hernia may occur beyond the neonatal period. CDH occurs in about 1 in 2000 births. The most common defect is the posterolateral (Bochdalek) type. Over 90% of the patients will be diagnosed either antenatally or will present with respiratory distress in the first few hours of life. In these cases there are few diagnostic problems. There is a significant mortality associated with this group. However about 5% to 30% of diaphragmatic hernias present beyond the neonatal period. Although the mortality in this group is low, the morbidity may be significant. The late presenting congenital diaphragmatic hernia poses considerable diagnostic and anaesthetic challenges because of its varied presentation often resulting in diagnostic delay, inappropriate treatment and potential fatal outcome. We report the successful anaesthetic management of a 9 month old infant who was planned to be operated for tension pneumothorax and finally diagnosed as CDH intraoperatively.
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