Intestinal obstructionCongenital diaphrogmatic herniaAlso known as ochalek hernia. There is herniation of abdominal contents, i.e. stomach (most of the time), intestine, liver; into thorax through a defect in the diaphragm. Females are affected more than males More common on left side and is posterolateral. Components of CDH areHerniation of abdominal contents into thorax Pulmonary hypoplasia Malrotation of intestineAssociated anomalies may be seen 30% of cases -> CNS lesions, esophageal atresia, omphalocele and CVS lesions. Most cases are sporadic. CDH is a reconized part of several chromosomal syndromes ---> Trisomy 21, 18, 13, turner syndrome, Pallister-Killian, Fryn.Clinical featuresCDH may present asSoon (within 6 hrs) after birth (most of the cases) or After neonatal period (small group)1)   Soon after birthRespiratory distress is a cardinal sign --> presents as tachypnea, grunting, chest retraction, cyanosis. Scaphoid abdomen Increased chest wall diameter Bowel sounds may be heard in the chest with decreased breath sound.Cardiac impulse is displaced away from the side of hernia.2)   After neonatal periodVomiting as a result of intestinal obstruction Mild respiratory symptomsOccasionally, incarceration of the intestine will proceed to ischemia with sepsis and shock.DiagnosisPrenatal ultrasound can diagnose CDH between 16 and 14 wk. After delivery chest X-ray and nasal gastric tube is all that is usually required to confirm the diagnosis.">