A diaphragmatic hernia is a condition in which an opening or defect in the diaphragm allows the abdominal organs to move into the chest cavity. The diaphragm is a muscle that separates the chest from the abdomen and helps with breathing. The lungs, heart, and other organs can suffer from a diaphragmatic hernia.
A diaphragmatic hernia can be congenital or acquired. A congenital diaphragmatic hernia (CDH) occurs at birth because the diaphragm does not develop properly during fetal development. CDH can occur on either side of the diaphragm, but it is more common on the left side of the diaphragm. The cause of CDH is unknown, but it may be linked to genetics, environment, or both.
In an acquired diaphragmatic hernia (ADH), the diaphragm is damaged or weakened by trauma, surgery, infection, or other factors. An ADH can occur on either side of the diaphragm, but it is more common on the right.
The symptoms of a diaphragmatic hernia depend on the size and location of the defect, the organs involved, and the severity of the condition. Some common symptoms include:
Difficulty breathing or shortness of breath
Rapid breathing or respiratory distress
Bluish skin color or cyanosis
Chest pain or discomfort
Abdominal pain or swelling
Nausea or vomiting
Heartburn or acid reflux
Reduced appetite or poor feeding
Failure to thrive or poor growth
Some diaphragmatic hernias may not cause any symptoms and may be discovered incidentally during a chest X-ray or other imaging tests.
An ultrasound, fetal MRI, or amniocentesis can be used to diagnose diaphragmatic hernias before or after birth, and a physical examination, chest X-ray, CT scan, MRI, or endoscopy can be used to diagnose them after birth.
The treatment of a diaphragmatic hernia depends on the type, size, and location of the defect, the organs involved, and the patient's overall health. During treatment, the patient's breathing and circulation will be supported, the defect will be repaired, and the organs' normal position and function will be restored.
Surgical procedures are usually necessary to close a diaphragmatic hernia and relocate the organs. Depending on the severity of the condition and the availability of resources, surgery can be performed before or after birth. Depending on the surgeon's preference and expertise, surgery can be performed using open or minimally invasive techniques.
Before and after surgery, the patient may need additional treatments and interventions, such as:
Mechanical ventilation or oxygen therapy to help with breathing
Medications to stabilize the blood pressure and heart rate
Intravenous fluids and nutrition to prevent dehydration and malnutrition
Antibiotics to prevent or treat infection
Pain relief to reduce discomfort and inflammation
Physiotherapy to improve lung function and mobility
A diaphragmatic hernia cannot be prevented in most cases, as the cause is unknown or unavoidable. However, some possible ways to reduce the risk or severity of a diaphragmatic hernia include:
Avoiding smoking, alcohol, and drugs during pregnancy
Taking prenatal vitamins and folic acid supplements as recommended by the doctor
Having regular prenatal check-ups and screenings to monitor the fetal development and health
Seeking prompt medical attention for any signs or symptoms of a diaphragmatic hernia
Following the doctor’s advice and instructions before and after surgery
Having regular follow-ups and evaluations to monitor the recovery and long-term outcomes
When diagnosed, treated, and cared for properly, diaphragmatic hernias can have a good quality of life and a normal life expectancy.
