Diaphragmatic hernia

Also known as: Hernia - diaphragmatic and Congenital hernia of the diaphragm (CDH)

Definition

A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm. The diaphragm is the muscle between the chest and abdomen that helps you breathe. The opening allows part of the organs from the belly to move into the chest cavity near the lungs.

Causes

A diaphragmatic hernia is a rare defect. It occurs while the baby is developing in the womb. Because the diaphragm is not fully developed, organs, such as the stomach, small intestine, spleen, part of the liver, and the kidney, may take up part of the chest cavity.

CDH most often involves only one side of the diaphragm. It is more common on the left side. Often, the lung tissue and blood vessels in the area do not develop normally either. It is not clear if the diaphragmatic hernia causes the underdeveloped lung tissue and blood vessels, or the other way around.

40% of babies with this condition have other problems as well. Having a parent or sibling with the condition increases the risk.

Symptoms

Severe breathing problems almost always develop shortly after the baby is born. This is due in part to poor movement of the diaphragm muscle and crowding of the lung tissue. Problems with breathing and oxygen levels are often due to underdeveloped lung tissue and blood vessels as well.

Other symptoms include:

Exams and Tests

Fetal ultrasound may show abdominal organs in the chest cavity. The pregnant woman may have a large amount of amniotic fluid.

An exam of the infant shows:

  • Irregular chest movements
  • Lack of breath sounds on side with the hernia
  • Bowel sounds that are heard in the chest
  • Abdomen that looks less protruberant than a normal newborn's and feels less full when touched

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

Treatment

A diaphragmatic hernia repair 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.

The infant will need breathing support during the recovery period. Some infants are placed on a heart/lung bypass machine to help deliver enough oxygen to the body.

If a diaphragmatic hernia is diagnosed early during pregnancy (before 24 to 28 weeks), fetal surgery may be an option in some situations.

Outlook (Prognosis)

The outcome of surgery depends on how well the baby's lungs have developed. It also depends on whether there are any other congenital problems. Most often the outlook is good for infants who have a sufficient amount of working lung tissue and have no other problems.

Medical advances have made it possible for over half of infants with this condition to survive. The babies survived will often have ongoing challenges with breathing, feeding, and growth.

Possible Complications

Complications may include:

  • 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. Couples with a family history of this problem may want to seek genetic counseling.

References

Keller RL, Guevara-Gallard S, Farmer DL. Surgical disorders of the chest and airways In: Gleason CA, Devaskar SU, eds. Avery's diseases of the newborn. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 49.

Tsao KJ, Lally KP. Congenital diaphragmatic hernia and eventration In: Holcomb GW, Murphy JP, Ostlie DJ, eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 24.

Review date:
December 7, 2016
Reviewed by:
Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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