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by Kohnle D
(Hernia—Diaphragmatic; Congenital Hernia of the Diaphragm)

Definition

Diaphragmatic hernia is a defect in which an opening is present in the diaphragm at birth. The diaphragm is the partition separating the chest and abdominal cavities. The abnormal opening allows some of the organs typically found in the abdomen to move into the chest cavity. In infants born with diaphragmatic hernia, the abdominal organs push up against the lungs. This prevents the lungs from developing normally.

Diaphragmatic hernia is a serious condition with many potential complications and side effects.

Causes

Diaphragmatic hernia is caused by a failure of the diaphragm to completely fuse during fetal development.

Diaphragmatic Hernia—Stomach and Intestines Move into Chest Cavity
Herniated Diaphragm
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase the chances of diaphragmatic hernia:

  • Chromosomal syndromes
  • Maternal alcohol use
  • Pregestational diabetes in the mother

Symptoms

Symptoms include:

  • Severe respiratory distress, including rapid breathing, grunting, use of accessory muscles, and bluish tint to the skin from lack of oxygen
  • Asymmetrical or increased diameter of the chest wall
  • Concave abdomen

Diagnosis

Diagnosis is frequently made on prenatal ultrasound.

If not found prior to birth, a physical exam will be done to confirm the presence of abdominal organs in the chest cavity.

Chest x-ray may also be taken.

Treatment

Treatment includes the following:

Surgery

Surgery to repair the defect and move the organs into the abdomen may be done. Surgery involves either sewing the edges of the diaphragm together, or if the hole is too large, using an artificial patch to fully close the hole. Fetal surgery may be an option, but it may not be available everywhere.

Respiratory Support

Aggressive respiratory support, including mechanical ventilation , is often needed. Different ventilator strategies may be used. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass, may be necessary.

Prevention

There are no current guidelines to prevent diaphragmatic hernia.

RESOURCES

Healthy Children—American Academy of Pediatrics  https://www.healthychildren.org 

Kids Health—Nemours Foundation  http://kidshealth.org 

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children  http://www.aboutkidshealth.ca 

Health Canada  https://www.canada.ca 

References

Congenital diaphragmatic hernia. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114158/Congenital-diaphragmatic-hernia  . Updated May 16, 2016. Accessed March 23, 2018.

Congenital diaphragmatic hernia (CDH). Cincinnati Children's website. Available at: https://www.cincinnatichildrens.org/health/c/diaphragmatic-hernias. Updated January 2016. Accessed March 23, 2018.

Congenital diaphragmatic hernia (CDH). UCSF Benioff Children's Hospital Fetal Treatment Center website. Available at: http://fetus.ucsf.edu/cdh. Accessed March 23, 2018.

McAteer JP, Hecht A, De Roos AJ, Goldin AB. Maternal medical and behavioral risk factors for congenital diaphragmatic hernia. J Pediatr Surg. 2014;49(1):34-38.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 03/2018
  • Update Date: 05/01/2014