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Diaphragmatic Hernia

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Introduction

The Diaphragm is a large muscle which separates the chest from the abdomen. A Diaphragmatic Hernia is a congenital malformation caused by a hole in the Diaphragm. This hole in the Diaphragm can cause organs such as the stomach, liver, and intestines to pass through the hole towards the Diaphragm and exert pressure on the baby’s chest.

The most adverse effect of Diaphragmatic Hernia is that once any organ passes through the hole, it hinders the baby’s lung formation causing excessive breathing problems at birth. It has been seen that children who suffer from Diaphragmatic Hernia also suffer from other birth defects such as defects of the heart, brain, or intestines.

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What are the causes of Diaphragmatic Hernia?

A Diaphragmatic Hernia can be of two types:

  • ● A Congenital Diaphragmatic Hernia and
  • ● An Acquired Diaphragmatic Hernia.

A Congenital Diaphragmatic Hernia is caused when the diaphragm of the foetus is abnormally formed. This causes the abdominal organs to move into the chest hindering lungs’ proper growth.

An Acquired Diaphragmatic Hernia is caused by an injury.  Accidents, gunshots, or stab wounds may damage the diaphragm leading to diaphragmatic hernia. In rare cases, patients are unaware that they are suffering from a Diaphragmatic Hernia until severe symptoms begin to show.

What are the symptoms of Diaphragmatic Hernia?

The symptoms of a diaphragmatic hernia are many:

  • ● Difficulty in breathing is very severe in both congenital diaphragmatic hernia and acquired Diaphragmatic Hernia. Breathing becomes difficult because the lung is crowded by other organs which exert pressure.
  • ● Tachypnea or rapid breathing is also a symptom of diaphragmatic hernia because the lungs work harder to make up for the body’s shortage of oxygen.
  • ● The abnormal growth of the lungs as in the case of congenital diaphragmatic hernia and the crowding of the lungs as in the case of an acquired Diaphragmatic Hernia, causes the lungs to receive very low levels of oxygen. This causes the colour of the skin to appear bluish (cyanosis).
  • ● The Diaphragmatic Hernia may cause tachycardia. A condition where the heart beats faster to supply oxygen to the body.
  • ● A common symptom of congenital diaphragmatic hernia is reduced or absent breath sound. This happens because the baby’s lungs are malformed because of the hernia.
  • ● When the baby’s intestines push its way through the diaphragm, there may be bowel sounds in the chest.
  • Upon palpation (a physical examination by pressing certain body parts, especially the abdomen), your abdomen may seem less, because the organs have pushed themselves to the chest area.
  • ● One side of the chest becomes larger than the other in the Diaphragmatic Hernia.

How is Diaphragmatic Hernia diagnosed?

Before birth, a Diaphragmatic Hernia is diagnosed through prenatal ultrasonography and other screening tests. During the ultrasound, the doctor will test the foetus’s chromosomes and measure the baby’s lung size. Doctors conduct an ultrasound to look for any abnormalities.

  • ● Your doctor may perform an amniocentesis (genetic testing) to see if there are any symptoms of Diaphragmatic Hernia.
  • ● After birth, the doctor may diagnose a Diaphragmatic Hernia by noticing breathing trouble in the child.
  • ● Your doctor will conduct an x-ray on the child to see if the organs have pushed their way through the diaphragm.
  • ● Your doctor might conduct an MRI (Magnetic Imaging Resonance) to test the Diaphragmatic Hernia severity.
  • ● Arterial blood gas test (blood is taken directly from an artery and levels of oxygen, acidity, pH level, and carbon dioxide are obtained).

How is Diaphragmatic Hernia treated?

Both congenital Diaphragmatic Hernia and acquired diaphragmatic hernia require urgent surgery. Your doctor will perform a surgery to place the abdominal organs back to their place which has moved to the chest area. After removing the abdominal organs, your doctor will repair the hole in the diaphragm.

In the case of a congenital Diaphragmatic Hernia, the doctor will perform surgery within 48 to 72 hours of childbirth. But before the surgery, it is necessary to stabilize the child to increase the oxygen levels. The doctors use various kinds of medicines and techniques to stabilise the baby and increase his oxygen levels to help him breathe. Babies suffering from congenital Diaphragmatic Hernia are kept in a Neonatal Intensive Care Unit (NICU) where they get highly specialised treatment. When the baby is stable, the doctors decide upon a surgery.

In the case of patients with an acquired Diaphragmatic Hernia, the patient is first made stable with oxygen and medicines. The patients of acquired diaphragmatic hernia are mostly the ones who have suffered an injury. Therefore, they may be suffering from other complications like internal bleeding. In such cases, the doctor will conduct surgery as soon as possible.

What do you mean by long-term outlook of Diaphragmatic Hernia?

The survival rate of Diaphragmatic Hernia is 70-90% worldwide according to current research. The long-term outlook of the congenital Diaphragmatic Hernia depends upon the severity of lung damage. The long-term outlook of the acquired Diaphragmatic Hernia depends upon the severity of injury acquired-, the patient’s age, health, and the severity of the hernia and damages to other organs.

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FAQ's

Does it Matter Where a Baby with Congenital Diaphragmatic Hernia is Born?

Babies born with Congenital Diaphragmatic Hernia require immediate care just after they are born. Therefore, they should be born in a place where neonatologists, neonatal surgical nurses, cardiologists, pulmonologists, nutritionists, and pediatric surgeons are present. Moreover, they should be born in a place where a Neonatal Intensive Care Unit (NICU) is available..

Can Babies Survive Diaphragmatic Hernia?

Most babies with Congenital Diaphragmatic Hernia will do very well in the long-term. Long-term outlook depends to a large extent on how much damage the lungs or other organs are.

What Are the Types of Congenital Diaphragmatic Hernia?

There are two types of Congenital Diaphragmatic Hernia, Bochdalek hernia and Morgagni hernia. In bochdalek hernia, the side and back portions of the diaphragm are affected. The liver, stomach and spleen push into the chest cavity. In Morgagni hernia, the front portion of the diaphragm is affected.

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