Diaphragmatic hernia

Definition

A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm, the muscle that helps you breathe. The opening allows part of the organs from the belly (stomach, spleen, liver, and intestines) to go up into the chest cavity near the lungs.

Alternative Names

Hernia - diaphragmatic; Congenital hernia of the diaphragm

Causes

A diaphragmatic hernia is caused by the improper joining of structures during fetal development. As a result, the abdominal organs such as the stomach, small intestine, spleen, part of the liver, and the kidney appear in the chest cavity. The lung tissue on the affected side is thus not allowed to completely develop.

Congenital diaphragmatic hernia is seen in 1 out of every 2,200 to 5,000 live births. Most affect the left side. Having a parent or sibling with the condition slightly increases your risk.

Symptoms

Severe breathing difficulty almost always develops shortly after the baby is born, because of ineffective movement of the diaphragm and crowding of the lung tissue, which causes collapse.

Other symptoms include:

• Bluish colored skin due to lack of oxygen
• Rapid breathing (tachypnea)
• Fast heart rate (tachycardia)

Exams and Tests

The pregnant mother may have excessive amounts of amniotic fluid. Fetal ultrasound may show abdominal contents in the chest cavity.

Examination of the infant shows:

• Irregular chest movements
• Absent breath sounds on affected side
• Bowel sounds heard in the chest
• Abdomen feels less full on examination by touch (palpation)

A chest x-ray may show abdominal organs in chest cavity.

Treatment

A diaphragmatic hernia is an emergency that requires surgery. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm.

See: Diaphragmatic hernia repair - congenital

The infant will need breathing support until he or she recovers from surgery. Some infants are placed on a heart/lung bypass machine, which gives the lungs a chance to recover and expand after surgery.

If a diaphragmatic hernia is diagnosed during pregnancy (around 24 to 28 weeks), fetal surgery may be considered.

Outlook (Prognosis)

The outcome of surgery depends on how well the baby's lungs have developed and also on whether there are any other congenital problems. Usually the outlook is very good for infants who have enough lung tissue and have no other problems.

With advances in neonatal and surgical care, survival is now greater than 80%.

Possible Complications

• Lung infections
• Other congenital problems

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911). A diaphragmatic hernia is a surgical emergency.

Prevention

There is no known prevention.

References

Ehrlich PF, Coran AG. Diaphragmatic hernia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 101.

Keijzer R, Puri P. Congenital diaphragmatic hernia. Semin Pediatr Surg 2010 Aug; 19(3): 180-5.

Puri P, Nakazawa N. Congenital diaphragmatic hernia. In: Puri P, Hollworth M, eds. Pediatric surgery: diagnosis and management. Springer, 2009: chapter 31.

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