Delayed presentation of congenital diaphragmatic hernia with bowel obstruction in an 8-year-old, diagnostic value of chest X-ray as the sole imaging modality: a case report and literature review.

Introduction: Congenital diaphragmatic hernia (CDH) manifests as a result of incomplete closure of the diaphragm muscles during embryological development. Most cases are diagnosed during the antenatal period or may manifest during the first week of life. In this case, we have reported a child patient with a late-presenting left congenital diaphragmatic hernia with bowel obstruction diagnosed by an X-ray alone. Presentation of case: An 8-year-old boy presented with severe generalized abdominal pain, associated with vomiting, constipation, and difficulty in breathing. On examination, the child had a scaphoid abdomen with no audible bowel sounds. His chest had no air entry on the left side, audible bowel sounds on the left, mediastinal shift to the right side of the chest, and muffled heart sounds on the left side of the chest. Chest-abdominal X-ray, erect view, revealed multiple bowel loops in the left hemithorax with loss of the left hemithorax dome, cardiac silhouette shifted more to the right side of the chest. Emergency laparotomy was done with good post-operative recovery. Discussion: Delayed (late-presenting) congenital diaphragmatic hernia (CDH) is an uncommon clinical entity that poses diagnostic and therapeutic challenges because it often presents outside the neonatal period with heterogeneous respiratory or gastrointestinal symptoms and is frequently misdiagnosed. Conclusion: This report reinforces the need for clinicians - particularly in resource-limited settings - to consider CDH in older children with compatible clinical and radiographic features and demonstrates that timely surgery based on careful chest radiograph interpretation can lead to good outcomes.