A life-threatening breathing emergency in a two-year-old child led doctors at ITSA Hospitals to diagnose and successfully treat a rare Congenital Diaphragmatic Hernia (CDH) – a birth defect that had remained undetected since birth.
What initially appeared to be a chest injury turned out to be a complex congenital condition requiring rapid diagnosis, advanced imaging, emergency critical care, and expert pediatric surgery. Thanks to the coordinated efforts of a multidisciplinary team, the child made a successful recovery, highlighting the importance of specialised pediatric care and timely intervention.
The child was brought to ITSA Hospitals in critical condition after developing severe breathing difficulty following a minor injury at home.
At the initial healthcare facility, the condition was suspected to be tension pneumothorax, a medical emergency in which trapped air inside the chest places pressure on the lungs and heart, making breathing extremely difficult. An emergency chest tube was inserted, but despite initial treatment, the child’s condition continued to worsen.
The child was intubated and referred to ITSA Hospitals for advanced pediatric emergency and critical care.
Upon arrival, the Pediatric Emergency and Critical Care team immediately initiated advanced life-support measures.
The child was stabilised with ventilator support, continuous monitoring, and intensive critical care under the leadership of Dr. Sachin Pitlawar, Director and Senior Consultant Neonatologist & Pediatrician, along with Dr. Swasti Keshri, Consultant Pediatric Intensivist.
Although the child had been referred with a suspected chest injury, the clinical findings prompted the team to investigate further before proceeding with additional treatment.
A detailed chest X-ray showed an unusual abnormality that did not match the initial diagnosis.
Further radiological evaluation by Dr. Devvrat Dubey, Consultant Radiologist, confirmed the presence of a left-sided Congenital Diaphragmatic Hernia (CDH).
Congenital Diaphragmatic Hernia is a rare birth defect in which an opening develops in the diaphragm, allowing abdominal organs such as the stomach, intestines, or spleen to move into the chest cavity. As these organs occupy space inside the chest, they compress the lungs and interfere with normal breathing.
Most cases of CDH are diagnosed during pregnancy or shortly after birth. Identifying the condition for the first time in a two-year-old child is extremely uncommon, making this case particularly rare.
Congenital Diaphragmatic Hernia (CDH) occurs when the diaphragm—the muscle separating the chest from the abdomen—fails to develop completely during fetal growth.
The resulting opening allows abdominal organs to migrate into the chest cavity, reducing lung space and affecting breathing.
While severe cases are often detected before birth through prenatal ultrasound, some children with smaller defects may remain symptom-free for months or even years before presenting with breathing problems or gastrointestinal symptoms.
Late-presenting CDH can sometimes resemble other chest emergencies, making accurate diagnosis especially challenging.
After stabilising the child’s condition, the pediatric surgery team proceeded with definitive treatment.
Dr. Tanmay Motiwala, Consultant Pediatric Surgeon, successfully performed the surgery by carefully repositioning the stomach, small intestine, part of the large intestine, and spleen back into the abdominal cavity.
The diaphragmatic defect was then repaired to restore the normal separation between the chest and abdomen.
The procedure successfully relieved pressure on the lungs and corrected the underlying congenital abnormality.
The child’s anesthesia and peri-operative care were managed by Dr. Md. Asrar Siddiqui, Department of Anesthesiology & Critical Care.
Following surgery, the child was closely monitored in the Pediatric Intensive Care Unit (PICU), where specialised critical care teams managed ventilator support, pain control, respiratory recovery, and overall post-operative care.
As the child’s condition steadily improved, ventilator support was gradually withdrawn, and the child is now recovering well.
Speaking about the case, Dr. Tanmay Motiwala explained:
“Delayed presentation of Congenital Diaphragmatic Hernia is rare and can easily mimic other chest emergencies, particularly following trauma. Early diagnosis, timely surgery, and coordinated multidisciplinary care are essential for achieving successful outcomes.”
This case demonstrates how careful clinical evaluation and advanced diagnostic imaging can uncover hidden congenital conditions that may otherwise be mistaken for more common emergencies.
Although late-presenting Congenital Diaphragmatic Hernia is uncommon, parents should seek immediate medical attention if a child develops:
Early evaluation by pediatric specialists can help identify serious underlying conditions before complications become life-threatening.
Managing complex pediatric emergencies requires much more than emergency treatment. It demands seamless collaboration between pediatric emergency physicians, intensivists, radiologists, pediatric surgeons, anesthesiologists, and critical care specialists.
This successful case reflects ITSA Hospitals’ commitment to delivering advanced pediatric emergency care, specialized pediatric surgery, state-of-the-art diagnostics, and multidisciplinary teamwork under one roof.
By combining clinical expertise with advanced medical infrastructure, ITSA Hospitals continues to provide comprehensive care for even the most challenging and rare pediatric conditions, giving children and families access to world-class treatment closer to home.
No additional news found.