Delayed Recurrence of Congenital Diaphragmatic Hernia: A Case Report

Congenital diaphragmatic hernias (CDHs) are uncommon developmental defects of the diaphragm that may be complicated by the herniation of abdominal viscera into the thoracic cavity, pulmonary hypoplasia, and cardiorespiratory compromise.Surgical repair remains the only definitive treatment of CDH, with most patients with clinically significant disease undergoing surgery during the neonatal period or infancy.Recurrence following surgical repair is a recognized complication and typically develops within a few years of life; delayed, symptomatic recurrence presenting in adulthood is exceptionally rare.We report a rare case of a very late recurrence of a diaphragmatic hernia in a middle-aged female who presented with non-specific chest symptoms, more than three decades following initial surgery for CDH.Evaluation revealed a near-total collapse of the left lung with herniated intrathoracic bowel loops, the spleen, and the tail of the pancreas.The patient underwent elective laparoscopic repair, accomplished with careful adhesiolysis, reduction of herniated contents, and a darning technique using non-absorbable sutures to create a stable bed, followed by reinforcement with a synthetic polypropylene mesh to close the large 8 cm diaphragmatic defect.The postoperative course was uneventful, and at nearly 2 years of follow-up, she remains asymptomatic with radiological evidence of complete lung re-expansion and no recurrence of herniation.The case illustrates the possibility of very late, major recurrences following initial CDH repair.It highlights the importance of maintaining a strong index of suspicion in adults with a history of CDH presenting with unexplained thoracic symptoms.Furthermore, it demonstrates that, in appropriately selected patients and experienced centers, minimally invasive laparoscopic repair with prosthetic mesh reinforcement can be a safe and effective therapeutic option for CDH recurrences.