Mystery Diagnosis on DHC

[o1les]

I just watched an episode of Mystery Diagnosis on Discovery Health. There was a 3 year old that had severe vommiting and constipation off and on since birth. After being passed off as a virus for years it was discovered that the kid has a D-Hernia. His stomach and part of his large intestine were in the chest cavity. His only symptoms mentioned were vommiting/constipation. I'm having a hard time figuring out how this kid had no respiratory issues?? Can somebody help me figure this one out?

[EricJRN, MSN, RN]

Some very small diaphragmatic hernias don't present early on or with marked respiratory distress. eMedicine has good links on both congenital and acquired diaghragmatic hernias:

http://www.emedicine.com/MED/topic2979.htm

http://www.emedicine.com/med/topic3487.htm

[elizabells, BSN, RN]

Here's something I learned the hard way to pass along to y'all:

When you have a kid with CDH, no matter if they're two months post-op, and they start fussing and vomiting (when that's not their norm, CDH kids can be pukey all on their own), PAGE SURGERY. I was new and I let the intern (who was left alone on call overnight on her first shift in the NICU, but that's another thread) convince me that I had been burping her too hard and oh, let's just do a sepsis workup for her increasing resp distress and FiO2 requirement... that lasted about an hour before I came to my senses and demanded a CXR. Oh look. She reherniated.

[SteveNNP, MSN, NP]

There is a form of CDH where the herniation is midline, with loops of bowel behind the heart. This form tends to be smaller, less severe, and often asymptomatic. Since it wasn't severe enough to be picked up on US prenatally, I'm not surprised the kid did fine until now.