Late presentation of Bochdalek congenital diaphragmatic hernia associated with malrotation in a 7-year-old child: A case report

Introduction: Congenital diaphragmatic hernia (CDH) usually presents with respiratory distress at birth, which can be severe enough to cause cardiorespiratory failure. Late presentation of CDH is less common. CDH can be associated with malrotation, which is typically asymptomatic. Case presentation: We describe a case of a 7-year-old child who had non-specific gastrointestinal symptoms and no respiratory symptoms. The patient had been suffering from non-bilious vomiting for a week, had abdominal pain and was dehydrated and malnourished. Breath sounds were diminished and bowel sounds were present in the left hemithorax. A diagnosis of CDH was suggested on a chest x-ray and confirmed by a barium study. On exploration, a small-sized left CDH associated with malrotation and Ladd's bands were discovered. The diaphragmatic defect was closed primarily, and the malrotation corrected with a Ladd's procedure. The post-operative course was uneventful. Conclusion: Patients with non-specific gastrointestinal symptoms and a suspicious chest X-ray should undergo further imaging studies to rule out a CDH. Failure to do so can potentially lead to complications such as bowel obstruction and volvulus. Respiratory symptoms are uncommon in late-presenting CDH.