Congenital Diaphragmatic Hernia Considerations for the Adult General Surgeon

CDH is a surgical disease primarily of the newborn infant. Most cases are diagnosed prenatally using screening ultrasound, enabling timely multidisciplinary consultation and planning at a tertiary care center. A minority of cases are diagnosed in the newborn period when infants with acute respiratory distress are found to have abdom-inal viscera in the chest on plain X-rays. For newborn infants, management involves immediate endotracheal intubation with gentle ventilation, placement of an OGT or NGT, judicious fluid resuscitation, and timely echocardiographic evaluation to assess the degree of pulmonary hypertension and to diagnose any associated congenital heart anomalies. Pulmonary hypertension is medically optimized before definitive operative repair. Some infants may need extracorporeal life support in cases of severe pulmonary hypertension or lung hypoplasia. Infants with large defects or hemidiaph-ragm agenesis may require prosthetic patches or abdominal wall muscle flap repair. Infants with repaired CDH often have ongoing morbidities, including chronic lung dis-ease, neurocognitive deficits, hearing loss, gastroesophageal reflux, bowel obstruc-tion, chest wall deformities, and vascular anomalies in the neck if they have undergone ECMO. Cases of previously occult CDH may present acutely in the older child or adult with gastrointestinal or pulmonary symptoms. The adult general surgeon must be able to recognize infants with CDH, help direct initial resuscitation and transfer to a higher level of care, be familiar with repair principles of CDH diagnosed in older children and adults, and understand the comorbidities and surgical implications of CDH patients who survive into adulthood.

Automated summary

Congenital diaphragmatic hernia (CDH) is a surgical disease primarily affecting newborn infants, requiring timely diagnosis and treatment. Management involves interventions such as endotracheal intubation, fluid resuscitation, and echocardiographic evaluation. After surgical repair, infants may experience various morbidities.