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Two Case Reports and a Review of the Literature

Frederick J. Rescorla, MD; Mervin C. Yoder, MD; Karen W. West, MD; Jay L. Grosfeld, MD

Arch Surg. 1989;124(9):1083-1086.

Abstract
• Group B streptococcal sepsis was associated with delayed presentation of an unsuspected right-sided diaphragmatic hernia in two neonates. These unusual clinical observations and a review of 24 similar cases from the literature form the basis of this report. Infants present with respiratory distress during the first few hours of life and have group B streptococcal sepsis confirmed by results of blood cultures. The right side of the diaphragm appears normal on the initial chest roentgenogram in the majority of cases. After initial improvement with antibiotic therapy and ventilatory support, sudden deterioration of respiratory status may occur. Subsequent chest roentgenograms often demonstrate herniated viscera in half of the cases, while ultrasound examination, isotopic liver scan, and peritoneography are useful in achieving a diagnosis in the other cases. If recognized, survival is 100% following hernia repair. Persistent respiratory symptoms in a neonate who is recovering from group B streptococcal sepsis should prompt a careful evaluation of the right side of the diaphragm for the presence of an unsuspected posterolateral hernia.

(Arch Surg 1989;124:1083-1086)

Author Affiliations
From the Section of Pediatric Surgery, Department of Surgery (Drs Rescorla, West, and Grosfeld), and the Section of Neonatal-Perinatal Medicine, Department of Pediatrics (Dr Yoder), Indiana University School of Medicine, and the James Whitcomb Riley Hospital for Children, Indianapolis.

Footnotes
Accepted for publication April 22, 1988.

Reprint requests to James Whitcomb Riley Hospital for Children, 702 Barnhill Dr (K-21), Indianapolis, IN 46223 (Dr Grosfeld).

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