Diaphragmatic Hernia

Alternative names: congenital hernia of the diaphragm; hernia - diaphragmatic   

Definition: An abnormal opening in the diaphragm that allows part of the abdominal organs to migrate into the chest cavity, occurring before birth. 

Causes, incidence, and risk factors: A diaphragmatic hernia is caused by the improper fusion of structures during fetal development. 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 has usually not developed fully. Respiratory distress usually develops shortly after the baby is born or pulmonary artery hypertension and or pulmonary hypoplasia both complicate care. 

Symptoms: 

  • severe breathing difficulty 
  • bluish coloration of the skin due to lack of oxygen 
  • breathing, absent temporarily 
     

Signs and tests: The pregnant mother may have shown signs of polyhydramnios (excessive amounts of amniotic fluid). 

Examination of the infant shows:  chest movements asymmetric with breathing breath sounds absent on the affected side bowel sounds heard in the chest concave abdomen that 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 urgent surgical condition. The abdominal organs must be replaced into the abdominal cavity, and the opening in the diaphragm repaired. Support of the respiratory system is often necessary immediately after birth until the infant recovers from surgery. Many times aggressive NICU care is necessary prior to hernia repair.

Expectations (prognosis): The lung tissue may be underdeveloped on the affected side, and the outcome depends upon the development of the lung tissue. Infants who survive may have some long-term lung disease. 

Complications: pulmonary (lung) infections other congenital anomalies may be present. As with any procedure we perform, your child's safety and well-being our #1 priority.  As always, feel free to contact us with any question that you have.  We would be happy to answer it for you.