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Diaphragmatic Hernias Print E-mail

Dr. Kennedy A. diaphragmatic hernia involves the passage of a loop of bowel through the diaphragm muscle. This type of hernia occurs as the bowel from the abdomen "herniates" upward through the diaphragm into the chest cavity. Diaphragmatic hernias may be congenital or acquired.

Congenital Diaphragmatic Hernias

Congenital diaphragmatic hernias are present at birth. They occur because of abnormal development of the embryo. The term is used most commonly in reference to Bochdalek hernia, however it can also apply to Morgagni's hernia, diaphragm eventration and central tendon defects of the diaphragm. The common theme is malformation of the diaphragm; this allows the abdominal viscera to protrude into the chest cavity impeding proper lung formation. Newborns with CDH often have severe respiratory distress which can be life-threatening unless treated appropriately. Failure of the lungs to develop correctly (pulmonary hypoplasia) is the central problem with congenital diaphragmatic hernia.

Bochdalek Hernia

The Bochdalek hernia, aka postero-lateral diaphragmatic hernia, is the most common congenital diaphragmatic hernia, accounting for more than 95% of cases. The diaphragm abnormality is a hole in the postero-lateral corner of the diaphragm which allows passage of the abdominal viscera into the chest cavity. The majority of Bochdalek hernias (85%) occur on the left side of the diaphragm, a large proportion of the remaining cases occur on the right side, and a small fraction are bilateral.

Morgagni's Hernia

Morgagni's accounts for only about 2% of congenital hernias and is characterized by herniation through the foramina of Morgagni located immediately adjacent to the xyphoid process of the sternum. The majority of hernias occur on the right side of the body and are uaually asymptomatic. However, newborns may present with respiratory distress at birth similar to Bochdalek hernia. Also, chest infections and GI symptoms have been reported in those with previously undiagnosed Morgagni's hernia. In asymptomatic individuals laparoscopic surgical repair is still recommended as they are at risk of a strangulated intestine.

Acquired Diaphragmatic Hernias

These are referred to as hiatal hernias and occur usually in adulthood. They are caused by increased pressure in the abdomen, most often from heavy lifting or frequent bending over, frequent or hard coughing, hard sneezing, pregnancy and delivery, violent vomiting, straining with constipation, obesity , straining at stool, and heredity. Upper GI endoscopy depicting hiatus hernia.The diagnosis of a hiatus hernia is typically made through an upper GI series or endoscopy and treatment may be as simple as oral medication or as complicated as abdominal surgery.

The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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