Congenital diaphragmatic hernia

In a diaphragmatic hernia are displaced by a vulnerability or gap in the diaphragm abdominal organs into the chest cavity.

Molding

There are congenital and acquired diaphragmatic hernia. The congenital forms are malformations. Through a gap in the diaphragm abdominal organs to enter the chest ( stomach, intestines, liver, spleen ). Sometimes they are associated with other malformations.

When an acquired diaphragmatic hernia usually the stomach next to the esophagus passes upward into the chest, so in these hiatal hernias abdominal cavity contents imposed by the slit-shaped diaphragm opening, which runs through the esophagus ( esophageal hiatus ).

Are the upwardly displaced organs of the peritoneum covered - that is a so-called hernia sac before - this is called a true hernia. In the congenital hernia often is no hernial sac.

Congenital diaphragmatic hernia

Frequency

Congenital diaphragmatic hernia: 2-5 of 10,000 births. In 80-90 % of cases there is the gap on the left side.

Cause and consequences

Disturbed development of the diaphragm: The diaphragm develops in the 8th to 10th week of pregnancy. If, in the development of a disorder in which a gap in the diaphragm arises, slip in the aftermath abdominal organs into the chest. If the right diaphragmatic hernia, these are mostly fractions of liver and intestine on the left side, it is usually the stomach, intestines, spleen and possibly portions of the liver. Depending on how much space these organs take then in the chest, the lungs are restricted in their development. This is on the one hand to a reducing growth of the lung and often in addition to a displacement of the heart. In the lung tissue can be found in addition often a vascular malformation that leads to the birth to circulatory problems.

Diagnostics

Congenital diaphragmatic hernia can be represented before birth by ultrasound from the 18th week of pregnancy. If such a diagnosis is made prenatally, further studies should (eg MRI ) carried out in a specialized center in order to assess the degree of prenatal lung injury can that significantly influenced the prognosis for the survival of children and the targeted primary care.

After birth, the children fall on by shortness of breath, a radiograph of the chest then shows that in the chest are still other organs except the lungs and heart.

Therapy

If the hernia is detected before birth, the delivery should be planned in consultation with a specialist center. In some selected cases, is already suggest a therapy in utero, wherein a balloon is placed in the trachea for a certain time, which is then removed prior to delivery.

The confinement should otherwise be done by planned caesarean section at a center with attached neonatal intensive care and pediatric surgery. After birth, the child is immediately intubated and ventilated and provided with a gastric tube to prevent air from entering the parts of the gastrointestinal tract that are in the chest. This would otherwise need through the air introduced even more space, thereby pressing on the lung and thus obstruct breathing on. After the first aid the transfer is done in the neonatal intensive care unit. The child is there initially stabilized and search for other malformations.

If there is a very poor lung function, the use of ECMO ( Extracorporeal membrane oxygenation Oral ) may be necessary to ensure the survival of children.

Only after sufficient stabilization of the child, the correction operation is planned and carried out. It should be noted here that many children live through shortly after birth, a so-called " honeymoon phase " in which they are doing relatively well for a few hours, but then got bigger problems on the part of respiration and circulation. After a re- stabilization, the operation can be planned.

During the operation the organs of the thorax are moved back into the abdomen and closed the gap in the diaphragm. The gap is so great that the diaphragm muscle is not sewn to each other, either foreign material is sewn or by using a part of the muscles of the abdominal wall as a substitute for the diaphragm.

When retracting the abdominal organs in the abdominal cavity, it may happen that does not offer this enough space. In such a case, the abdominal cavity is also closed by foreign material that is subsequently removed.

Forecast

Survival rates vary depending on the center of between 70 and 90 %.

Is the gap in the diaphragm size, may further operations are necessary, for example, the exchange of the foreign material in the course of growth.

Acquired diaphragmatic hernia

In addition to the congenital hernias, ie in which the hernia sac is formed at birth or in the womb, hernias can be caused by pre-existing gaps in later life. If the fracture gap of the esophageal hiatus, the hernia is therefore called hiatal hernia. This is the most common form of acquired diaphragmatic hernia.

If the breakage but other gaps so this eponymous (with Morgagni, Bochdalek or Larrey hernia ).

Sources and links

• Disease in pediatric surgery
• Disease in visceral surgery
• Malformation
• Fetal Surgery
• Diaphragm