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.
2. What is
Diaphragmatic
Hernia?
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.
3. Explanation of Diaphragmatic Hernia with Visual
▪ This is a photo of a peritoneopericardial
diaphragmatic hernia in a cat.
▪ The photo was taken during necropsy from
the right side of the cat.
▪ To the left is the abdomen, where part of
the liver and the gall bladder can be seen.
▪ The diaphragm is in the middle. To the
right is the thorax.
▪ The largest object seen in the thorax is the
rest of the liver.
▪ Just to the right of that is the heart.
▪ The liver was connected to itself through a
small hole in the diaphragm (not seen).
4. What are the types of Diaphragmatic Hernia?
▪ Congenital diaphragmatic hernia
▪ Congenital diaphragmatic hernia (CDH) is a birth defect of the diaphragm.
▪ Morgagni's hernia
▪ This rare anterior defect of the diaphragm is variably referred to as a Morgagni, retrosternal, or parasternal hernia.
▪ Accounting for approximately 2% of all CDH cases, it is characterized by herniation through the foramina of Morgagni
which are located immediately adjacent and posterior to the xiphoid process of the sternum.
▪ Bochdalek hernia
▪ The Bochdalek hernia, also known as a postero-lateral diaphragmatic hernia, is the most common manifestation of
CDH, accounting for more than 95% of cases.
▪ Hiatal hernia
▪ A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the
middle compartment of the chest.
▪ Iatrogenic diaphragmatic hernia
▪ Iatrogenic diaphragmatic hernia is rare complications of thoracic or abdominal surgery, having been described following
esophagectomy (1), gastrectomy (2), laparoscopic cholecystectomy (3), and nephrectomy (4).
▪ Traumatic diaphragmatic hernia
▪ Diaphragmatic rupture (also called diaphragmatic injury or tear) is a tear of the diaphragm, the muscle across the
bottom of the ribcage that plays a crucial role in breathing.
5. What is the path physiology of Diaphragmatic
Hernia?
▪ The pathophysiology of acquired diaphragmatic hernias includes
circulatory and respiratory depression secondary to decreased
function of the diaphragm, intrathoracic abdominal contents
leading to compression of the lungs, shifting of the mediastinum,
and cardiac compromise.
6. What are the causes of a Diaphragmatic Hernia?
▪ A congenital diaphragmatic hernia (CDH) is due to 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 usually 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.
7. How Many Babies are Born with Diaphragmatic
Hernia?
▪ Researchers estimate that about 1 in every 3,600 babies is born
with diaphragmatic hernia in the United States.
▪ About half of all newborns who have diaphragmatic hernia also
have other conditions, including birth defects of the brain, heart,
and intestines.
8. What are the risk factors for a Diaphragmatic
Hernia?
▪ Most congenital diaphragmatic hernias are idiopathic; their cause is unknown.
▪ It is believed a combination of several factors lead to their development.
▪ Chromosomal and genetic abnormalities, environmental exposures and
nutritional problems may all have a role in the formation of these hernias.
▪ It can also occur with other organ problems such as abnormal development of
the heart, gastrointestinal, or genitourinary systems.
▪ The following factors may increase your risk of an acquired diaphragmatic
hernia:
▪ blunt injuries due to a traffic accident
▪ surgical procedures on the chest or abdomen
▪ falls that impact the diaphragm region
▪ stab wounds
▪ gunshot wounds
9. What are the symptoms of a Diaphragmatic
Hernia?
▪ The severity of symptoms with a diaphragmatic hernia can vary
depending on its size, cause, and the organs involved.
▪ Difficulty Breathing
▪ Tachypnea (rapid breathing)
▪ Blue discoloration of the skin
▪ Tachycardia (rapid heart rate)
▪ Diminished or absent breath sounds
▪ Bowel sounds in the chest area
▪ Less full abdomen
10. Difficult Breathing
▪ This is usually very severe. In a
CDH, it results from the abnormal
development of the lungs.
▪ In an ADH, it occurs when the
lungs can’t function properly due
to crowding.
11. Tachypnea (rapid breathing)
▪ Your lungs may try to
compensate for the low levels of
oxygen in your body by working at
a faster rate.
12. Blue discoloration of the skin
▪ When your body doesn’t receive
enough oxygen from your lungs,
it can make your skin appear
blue (cyanosis).
13. Tachycardia (rapid heart rate)
▪ Your heart may pump more
rapidly than normal to try to
supply your body with oxygenated
blood.
14. Diminished or absent breath sounds
▪ This symptom is common in the
case of a CDH because one of
the baby’s lungs may not have
formed properly.
▪ The breath sounds on the
affected side will be absent or
very difficult to hear.
15. Bowel sounds in the chest area
▪ This occurs when your intestines
move up into your chest cavity.
16. 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.
17. How is a Diaphragmatic Hernia diagnosed?
▪ Doctors can usually diagnose a congenital diaphragmatic hernia before the
baby is born.
▪ About half the cases are revealed during an ultrasound examination of the
fetus.
▪ There may also be an increased amount of amniotic fluid (the fluid that
surrounds and protects the fetus) within the uterus.
▪ After birth, the following abnormalities may appear during a physical
examination:
▪ abnormal chest movements
▪ difficulty breathing
▪ blue discoloration to the skin (cyanosis)
▪ absent breath sounds on one side of the chest
▪ bowel sounds in chest
▪ a “half-empty” feeling abdomen
18. How is a Diaphragmatic Hernia diagnosed?
(Contd..)
▪ The following tests are usually sufficient to diagnose either a CDH
or an ADH:
▪ X-ray
▪ ultrasound scan (uses sound waves to produce images of the thoracic
and abdominal cavities and their contents)
▪ CT scan (allows for direct viewing of the abdominal organs)
▪ arterial blood gas test (takes blood directly from an artery and tests for
levels of oxygen, carbon dioxide, and acidity, or pH level)
▪ MRI (for more focused evaluation of organs especially in a fetus)
19. How is a Diaphragmatic Hernia treated?
▪ Both congenital and acquired
diaphragmatic hernias typically
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.
20. How is a Diaphragmatic Hernia treated? (Contd..)
▪ 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.
22. How can a Diaphragmatic Hernia be prevented?
▪ Currently, there is no known way to prevent a CDH.
▪ Early and regular prenatal care during pregnancy is important to help
detect the problem before birth.
▪ This allows for proper planning and care before, during, and after
delivery.
▪ Some basic preventive measures that can help you avoid an ADH
include:
▪ Driving safely and always wearing a seat belt.
▪ Avoiding activities that make you prone to significant blunt injuries to the
chest or abdomen, such as extreme sports.
▪ Limiting alcohol and avoiding drug use which can make you more prone to
accidents.
▪ Exercising caution around sharp objects, such as knives and scissors.
23. What is the long-term outlook for Diaphragmatic
Hernia?
▪ The outlook for a CDH depends on how damaged the lungs are, as
well as the severity of involvement of other organs.
▪ According to current research, the overall survival rate for
congenital diaphragmatic hernias is 70-90 percent.
▪ The survival rate for an ADH correlates directly with the type of
injury, age, and overall health of the individual, as well as the
severity of the hernia based on the size and other organs involved.
