Diaphragmatic Hernia

Background 

Hernias are abnormal profusion of the internal contents of abdominal ( visceral cavity)  from the muscular defect in the body. Diaphragmatic Hernia is there is abnormal profusion of abdominal organs in to the chest cavity. One of the important tasks of dome shaped diaphragm is to separate internal working of chest and abdominal cavities.

A diaphragmatic hernia occurs when one or more of your abdominal organs move upward into your chest through defect in diaphragmatic musculature. This can be a defect present at birth or acquired later in life from accidents or fall.

Causes of Diaphragmatic Hernia

A diaphragmatic hernia is a rare defect. This can occur when the baby is developing in the womb. The diaphragm may not fully develop because of which organs such as stomach, small intestine, spleen, part of liver and kidney may take up part of the chest cavity. It is more common on the left side. As a result, lungs can’t develop properly, this condition is called Congenital Diaphragmatic Hernia.

Diaphragmatic Hernia may also develop as a result of blunt or penetrating injury. Majority of blunt injuries are caused due to traffic accidents and fall from height. Surgery on abdomen or chest may also cause accidental damage to your diaphragm. This condition is called an acquired diaphragmatic hernia. 

Diaphragmatic hernia may usually not occur without a known reason or go undiagnosed for a period of time. The symptoms start appearing immediately.

Symptoms of Diaphragmatic Hernia

The symptoms would vary depending upon its size, cause and organs involved.

  • Difficulty in breathing
  • Rapid breathing (Your lungs may try to compensate for low level of oxygen in your body)
  • Blue discolouration of skin (This also may happen due to lack of oxygen)
  • Bowel sounds in chest wall
  • Diminished or absent breath sounds (This is common case when baby’s lungs are not properly formed)
  • Rapid heart rate

Diagnosis and investigations 

Doctors are usually able to diagnose diaphragmatic hernia before the baby is born. This is revealed through ultrasound examination of foetus. There may also be increased amount of fluid in uterus, the fluid that protects the foetus. 

After birth the above-mentioned symptoms can easily signify the existence of the condition.

The below mentioned test can also reveal if diaphragmatic hernia is present.

  • X- ray of the chest to confirm the initial diagnosis. 
  • MRI (This can give more focused evaluation of organs like foetus)
  • CT Scans (Direct viewing of abdominal organ)
  • Arterial Blood gas test (This reveals level of oxygen, carbon di oxide and ph levels in blood)

Treatment of  Diaphragmatic Hernia 

Both Congenital and Acquired diaphragmatic hernia will  require Surgery. Surgery is mainly performed to reduce the abdominal organs from the chest and place them back to their original position. Following which the diaphragm is repaired. 

If the baby is found to have diaphragmatic hernia after delivery then surgery is performed within 48 to 72 hours. First the infant is treated with variety of medications and techniques to stabilise and assist with breathing. Once the baby stabilises surgery is performed. 

Even in the case of Acquired Diaphragmatic Hernia surgery remains the mainstay of the treatment. Some patients present with chronic shortness of breath and occasionally with acute chest pain and breathlessness. This patients need appropriate investigations to confirm the diagnosis and plan the surgical management accordingly. 

The surgery can be done using minimal invasive surgery ( laparoscopic diaphragmatic hernia repair with mesh) or with conventional open surgery. Laparoscopic surgery provides extreme benefits in view of postoperative chest pain, breathing and recovery. The hospital stay after surgery is usually 2-5 days.

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