Objectives: Acquired diaphragmatic hernia (DH) is a rare yet serious complication following liver transplantation (LT) in pediatric patients. We aimed to describe six pediatric cases who developed DH following LT, characterize their clinical presentation and management, and provide an updated review of the existing literature.
Methods: This retrospective case series of pediatric patients who developed DH following LT and were followed up at Makassed Hospital, a tertiary referral center in East Jerusalem, between January 2015 and March 2025. Demographic characteristics, transplant details, clinical presentation, surgical management, and outcomes were extracted from medical records. In addition, a comprehensive literature review was conducted to identify previously reported cases of DH following pediatric LT.
Results: Six cases were identified. Based on the Ministry of Health referral records, indicating approximately 58 pediatric LTs from our region during the same period, this corresponds to an estimated incidence of about 10%. Median age at LT was 43 months, with DH developing after a median interval of 5.5 months. All patients received a left lateral segment graft, except for one who had a left lobe graft. Respiratory distress and abdominal pain were the predominant symptoms. Prompt primary surgical repair was performed in all patients. There was one case complicated by bowel ischemia, which required bowel resection. Recurrence was detected in one patient.
Conclusions: DH following LT is rare but well recognized. Increased awareness and early recognition are essential to ensure timely surgical management and favorable outcomes.
Keywords: diaphragmatic hernia; liver transplantation; pediatrics; surgical complications.
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