Table Of Contents
- What is Diaphragmatic Hernia?
- Types of Diaphragmatic Hernia
- Causes
- Symptoms
- How to Diagnose Diaphragmatic Hernia?
- Treatment
What is Diaphragmatic Hernia?
Diaphragmatic hernia is a defect or hole in the diaphragm that allows the abdominal contents to move into the chest cavity. Treatment is usually surgical. The diaphragm is a dome-shaped muscular barrier between the chest and abdominal cavities. It separates your heart and lungs from your abdominal organs (stomach, intestines, spleen, and liver).
A diaphragmatic hernia occurs when one or more of your abdominal organs move upward into your chest through a defect (opening) in the diaphragm. This kind of defect can be present at birth or acquired later in life. It’s always a medical emergency and requires prompt surgery to correct.
Types of Diaphragmatic Hernia
- Congenital diaphragmatic hernia (CDH)
- Acquired diaphragmatic hernia (ADH)
Causes
A congenital diaphragmatic hernia (CDH) occurs when the abnormal development of the diaphragm while the fetus is forming. A defect in the diaphragm of the fetus allows one or more of their abdominal organs to move into the chest and occupy the space where their lungs should be. As a result, the lungs can’t develop properly. In the majority of cases, this affects only one lung.
An acquired diaphragmatic hernia (ADH) is due to the result of a blunt or penetrating injury. Traffic accidents and falls cause the majority of blunt injuries. Penetrating injuries are usually due to stab or gunshot wounds. Surgery on the abdomen or chest may also cause accidental damage to your diaphragm. Rarely, the diaphragmatic hernia may occur without a known reason and go undiagnosed for a period of time, until it becomes severe enough to cause symptoms.
Symptoms
- Difficulty breathing- It occurs when the lungs can’t function properly due to crowding. This is usually very severe. In a CDH, it results from the abnormal development of the lungs.
- Tachypnea (rapid breathing), Your lungs may try to compensate for the low levels of oxygen in your body by working at a faster rate.
- Blue discoloration of the skin, When your body doesn’t receive enough oxygen from your lungs, it can make your skin appear blue (cyanosis).
- Tachycardia (rapid heart rate), your heart may pump more rapidly than normal to try to supply your body with oxygenated blood.
- Diminished or absent breath sounds, The breath sound on the affected side will be absent or very difficult to hear. It’s a common in the case of a CDH because one of the baby’s lungs may not have formed properly.
- Less full abdomen, Your abdomen may be less full than it should upon palpation (an examination of the body by pressing on certain areas). This is due to abdominal organs being pushed up into the chest cavity.
- Bowel sounds in the chest area, it occurs when your intestines move up into your chest cavity.
How to Diagnose Diaphragmatic Hernia?
Doctors can usually diagnose a congenital diaphragmatic hernia before the baby is bor/n during ultrasound examination of fetus. There may also be an increased amount of amniotic fluid (the fluid that surrounds and protects the fetus) within the uterus.
After birth, during physical examination:
- abnormal chest movements
- difficulty breathing
- blue discoloration to the skin (cyanosis)
- bowel sounds in chest
- absent breath sounds on one side of the chest
- a “half-empty” feeling abdomen
The following tests are usually sufficient to diagnose either a CDH or an ADH:
- Arterial blood gas test (takes blood directly from an artery and tests for levels of oxygen, carbon dioxide, and acidity, or pH level)
- Ultrasound scan (uses sound waves to produce images of the thoracic and abdominal cavities and their contents)
- MRI (for more focused evaluation of organs especially in a fetus)
- CT scan (allows for direct viewing of the abdominal organs)
- X-ray
Treatment
Congenital and Acquired diaphragmatic hernias typically both require urgent surgery. Surgery must be performed to remove the abdominal organs from the chest and place them back into the abdomen. The surgeon will then repair the diaphragm.
With a CDH, surgeons may perform surgery as early as 48 to 72 hours after the baby is delivered. Surgery may occur earlier in emergency situations or it may be delayed. Every case is different. The first step is to stabilize the baby and increase its oxygen levels. A variety of medications and techniques are used to help stabilize the infant and assist with breathing. These babies are best cared for at a center with a highly specialized Neonatal Intensive Care Unit (NICU). Once the baby stabilizes, then surgery can occur.
With an ADH, the patient typically needs to be stabilized before surgery. Because most cases of ADH are due to injury, there might be other complications such as internal bleeding. Therefore, the surgery should happen as soon as possible.
