Hernia diafragmática congénita derecha: Reporte de caso

Introduction:  Congenital diaphragmatic hernias (CDH) are injuries with high perinatal mortality, of which 85-90% of cases occur on the left side, 10-15% on the right and less than 5% bilateral. The interest in this clinical case arises due to the low incidence in the presentation of right congenital diaphragmatic hernia.

Description:  This is a case report of a male newborn with a right diaphragmatic hernia. Endotracheal intubation is performed at birth even without cutting the umbilical cord, to avoid further rise of intestinal loops. On clinical examination, auscultation revealed peristalsis in the right hemithorax and at the base of the left lung, with null sounds in the left lung apex. A chest x-ray was performed, which reported the presence of intestinal loops in the right thoracic cavity and in the left lung base and displacement of the mediastinum and heart to the left, so Pediatric Surgery was consulted and transferred to another center of health. The patient died 11 hours later without having performed the diaphragmatic hernioplasty procedure.

Discussion:  Although diaphragmatic hernia is a structural defect, the main complications and survival of this pathology are due to pulmonary hypoplasia and consequent respiratory failure. These respiratory complications depend on the gestational age at which the pathology began. Because symptoms usually appear in the first 24 hours, this pathology should be suspected in every newborn with progressive respiratory difficulty and absence of lung sounds.

Keywords:
Diaphragmatic hernia; pulmonary hypertension; congenital anomalies; case report