A diaphragmatic hernia is caused by a break in the continuity of the diaphragm, which causes the abdominal organs to invade into the chest, leading to various complications. What are the causes and symptoms of a diaphragmatic hernia?

Diaphragmatic herniais formed when the abdominal organs enter the chest due to a rupture in the diaphragm. The diaphragm is the main respiratory muscle in all mammals. It separates the abdominal cavity from the chest cavity. Its role is to regulate respiratory work through uncontrolled contraction and relaxation. The contraction of the diaphragm also causes an increase in pressure in the abdominal cavity, which facilitates defecation. Some situations lead to a break in its continuity, as a result of which the abdominal organs may tap into the chest leading to various complications, a condition we call a diaphragmatic hernia. Obese people, who under normal conditions already have increased pressure in the abdominal cavity, as well as elderly people whose tissues are more susceptible to damage, are more likely to develop diaphragmatic hernias. Sometimes, in these two groups, a diaphragmatic hernia may appear even during sudden pressure or considerable physical exertion. Other risk factors include, but are not limited to: lifting weights, chronic severe coughing, frequent or forced vomiting, and stress.

Types of diaphragmatic hernia

Basically, we can divide diaphragmatic hernias into two types: hernias proper and natural diaphragmatic hernias.

Proper herniasare those that arise in openings that, under physiological conditions, do not appear in the diaphragm. These are congenital diaphragmatic hernias, which include, among others, Bochdalek's and Morgagni's.

Bochdalek's hernia is more common and is the result of non-fusion of the pleural-visceral fissure in the posterolateral part of the diaphragm, mainly on the left side.

Morgagni's hernia is formed in the front of the diaphragm between its rib and sternal attachments.

There are other types of congenital hernia, but they are much rarer. Another hernia proper is acquired, most often traumatic. Post-traumatic diaphragmatic hernia may form onas a result of penetrating or non-penetrating injuries to the abdominal cavity or chest. In 75% of cases, these are blunt injuries, mainly in traffic accidents, and the remaining 25% are, for example, stab wounds or gunshot wounds.

Hernias of natural diaphragm openingsare diaphragms formed in the esophageal development. There are three types:

  • type I - sliding hernias
  • type II - esophageal hernias
  • type III - sliding-peresophageal hernias

Sliding hernia accounts for nearly 90% of hiatal hernias. It consists in the displacement of the esophagus in the esophageal development and the relaxation of its lower sphincter, and in this case the gastric opening is above the diaphragm. When this happens, stomach contents will be dumped back into the esophagus and will quickly cause symptoms such as heartburn, vomiting and chest pain.

A periophageal hernia arises when only the fundus of the stomach is moved to the chest and its curvature is greater, and the function of the cardia and lower esophageal sphincter is normal, therefore there will be non-specific symptoms, e.g. hernia sac inflammation, obstruction, cardiac arrhythmias or bleeding.

Diaphragmatic hernia: symptoms

The symptoms of a diaphragmatic hernia largely depend on the extent to which the abdominal organs compress the intestines of the chest. If there is compression of the lungs and large vessels, shortness of breath, ischemic symptoms, and hypotension may appear.

Congenital diaphragmatic hernialeads to impaired development of the lungs and their hypoplasia, because the abdominal organs inverted to the chest do not allow the lungs to mature properly. In newborns, this will manifest itself as respiratory and circulatory failure. Pulmonary vascular insufficiency leads to pulmonary hypertension from birth.

Traumatic diaphragmatic herniais characterized by sudden and early onset of shortness of breath, abdominal or thoracic pain, heartburn, and bloody vomiting. Sometimes, with penetrating injuries of the diaphragm, the holes that form in the diaphragm are so small that the disease does not appear until many years later. The symptomatology of hiatal hernias depends mainly on its type. Symptoms range from typical gastrointestinal disorders such as heartburn, vomiting, abdominal pain, to very unspecific such as the aforementioned arrhythmias, difficulty breathing, and chest pains that may mistakenly indicate other medical conditions.

Diaphragmatic hernia diagnosis

Congenital herniasdiaphragmatic are most often diagnosed in the prenatal period during ultrasound examination. Thanks to this, both parents and doctors are prepared for the need for quick surgical treatment immediately after delivery. In other cases, sometimes the abdominal examination will reveal the displacement of the abdominal organs to the chest, but most often, if there are no contraindications, the X-ray is performed immediately with the use of a contrast agent in the Trendelenburg position. Endoscopic examination of the upper gastrointestinal tract and computed tomography are also used to diagnose diaphragmatic hernias.

Diaphragmatic hernia: treatment

The method of choice in the treatment of diaphragmatic hernias is, of course, a surgical operation, which involves the removal of the abdominal organs from the chest with subsequent closure of the hernia gate. Very rarely, when the clinical condition allows it and the symptoms are not severe, only pharmacological treatment can be initiated to reduce the symptoms of gastroesophageal reflux.

Complications of diaphragmatic hernias

The diaphragmatic hernia can cause obstruction of the gastrointestinal tract, which can lead to peritonitis or mediastinitis, which are directly life-threatening conditions.

Congenital diaphragmatic hernia: prognosis

Congenital diaphragmatic hernia in more than half of the cases accompanies other birth defects that are lethal and contribute to intrauterine death. However, if a child is born with a diaphragmatic hernia, the risk of death is sometimes 40 percent. Fortunately, the dynamic development of neonatology leads to a better prognosis and significantly increases the survival of children with congenital diaphragmatic hernia. It is very important to maintain the pregnancy as long as possible in order to give the lungs a chance to develop, even in such difficult conditions.

Category:

Gastrology