We report a case of a male, term newborn with known left congenital diaphragmatic hernia (CDH) who presented with circulatory compromise requiring maximal inotropic support in the first 24 hours of life. Repeat X-ray at 24 hours showed pneumatosis intestinalis. Emergency laparotomy was performed for suspected necrotising enterocolitis. The terminal ileum to the sigmoid colon were frankly necrotic with multiple perforations. Subtotal colectomy was performed. Although the recovery was protracted, the baby had a favourable outcome with progressive weight gain on follow-up at 3, 6 and 9 months of age.
This case of CDH had a postnatal systemic instability that was more severe than predicted, and as well as assessing for persistent pulmonary hypertension of newborn should trigger immediate suspicion for other organ involvement.
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