Causes and risk factors
Diaphragmatic hernia is a congenital deformity or it can also be acquired. Congenital can be of two types – Bochdalek hernia that involves an opening on the left side of the diaphragm. The stomach, liver, spleen and/or intestines usually move up into the chest cavity. It is the commonest type. Morgagni hernia involves an opening on the right side of the diaphragm. The liver and/or intestines usually move up into the chest cavity. A diaphragmatic hernia is caused by the improper joining of structures during embryonic development. Genetic factors are responsible for most cases. Sometimes, other congenital defects are also present. Acquired causes include – gunshot wound, RTA, blunt trauma to chest, and penetrating injury to diaphragm muscle. Chemicals have been associated with diaphragmatic hernia.
Clinical presentation
Patient presents with abnormal shape of chest or abdomen. Patients with Morgagni hernia may be asymptomatic. Patients with Bochdalek diaphragmatic hernia show symptoms like difficulty in breathing, fast breathing, and tachycardia. There is cyanosis, abnormal chest development, with one side being larger than the other, and concavity of abdomen. There are irregular chest movements, lack of breathing sounds; instead bowel sounds are heard in the chest.
Investigation
Medical history by the patient and clinical examination by the doctor help in diagnosis. Chest x-ray is required. Echocardiography is recommended. CT scan of chest is done. The condition can be diagnosed in the intrauterine life.
Treatment
Treatment consists of surgical correction of the congenital deformity, i.e., diaphragmatic hernia repair. Surgery involves repositioning of the abdominal organs and closure of the diaphragmatic opening.
