DIAPHRAGMATIC HERNIA

by: REINHA MAE DG. DADUYA

DIAPHRAGMATIC HERNIA
Diaphragmatic hernia is a birth defect where there is a hole in the diaphragm (the large
muscle that separates the chest from the abdomen). Organs in the abdomen (such as
intestines, stomach, and liver) can move through the hole in the diaphragm and upwards
into a baby’s chest.
TERMINOLOGIES
• Congenital Diaphragmatic Hernia (CDH)
• Bochdalek Hernia
• Morgagni Hernia
• Congenital Neonatal Diaphragmatic Hernia
• Traumatic Diaphragmatic Hernia
• Post-Traumatic Diaphragmatic Hernia
• Acquired Diaphragmatic Hernia (ADH)
• Hiatus Hernia
• Spontaneous Diaphragmatic Hernia
Congenital Diaphragmatic Hernia (CDH)
• Congenital diaphragmatic hernia (CDH)
occurs when the diaphragm, the muscle
that separates the chest from the
abdomen, fails to close during prenatal
development.
• This opening allows contents of the
abdomen (stomach, intestines and/or
liver) to migrate into the chest,
impacting the growth and development
of the lungs.
• The lungs will be smaller than expected
(pulmonary hypoplasia), and will have
less developed blood vessels. This
causes high blood pressure in the lungs
(pulmonary hypertension).
Types of CDH
BOCHDALEK HERNIA
• Bochdalek hernias , also known as pleuroperitoneal hernias,
(alternative plural: herniae) are the commonest type of congenital
diaphragmatic hernia.
• They occur posteriorly and are due to a defect in the posterior
attachment of the diaphragm when there is a failure of
pleuroperitoneal membrane closure in utero.
• Retroperitoneal structures may prolapse through the defect, e.g.
retroperitoneal fat or left kidney.
MORGAGNI HERNIA

One of the congenital diaphragmatic hernias (CDHs), and are characterized by

herniation through the foramen of Morgagni. When compared to Bochdalek
hernias, Morgagni hernias tend to be:

• anterior
• more often right-sided (~90%)
• small
• rare (~2% of CDH)
• at low risk of prolapse
Acquired Diaphragmatic Hernia (ADH)
• An acquired diaphragmatic
hernia (ADH) is usually the result
of a blunt or penetrating injury.
Traffic accidents and falls cause
the majority of blunt injuries.
Penetrating injuries are usually
due to stab or gunshot wounds.
Congenital Neonatal Diaphragmatic Hernia
• Congenital diaphragmatic hernia
(CDH) occurs when there is a
hole in the diaphragm, which is
the thin sheet of muscle
separating the chest from the
abdomen. When this gap forms
during a fetus's development in
the womb, the bowel, stomach
or even the liver can move into
the chest cavity.
Traumatic Diaphragmatic Hernia
• Traumatic diaphragmatic hernia
(TDH) is an uncommon disease,
encountered in 0.8% to 6% of
blunt trauma and more than 17%
of thoraco-abdominal-
penetrating trauma.[1–6] In the
acute phase, TDH is often
coupled with other thoraco-
abdominal, cerebral, or
musculoskeletal injuries.
Post-Traumatic Diaphragmatic Hernia
• Post- traumatic diaphragmatic
hernia is not an uncommon
sequel. But lack of awareness of
this condition may delay in
diagnosis and result in life-
threatening complications. CT
scan is regarded as the
investigative tool of choice but
some prefer Barium studies in
delayed cases of diaphragmatic
hernia.
Hiatus Hernia
• Hiatus hernia is the term used to
describe a condition where part
of the stomach pushes up into
the lower chest through a
weakness in the diaphragm.
• The diaphragm is the large flat
muscle that separates the lungs
from the tummy (abdomen) and
helps us to breathe. Not
everyone with a hiatus hernia
develops symptoms.
SPONTANEOUS DIAPHRAGMATIC
HERNIA
• A spontaneous diaphragmatic
hernia (SDH) occurs when intra-
abdominal contents extend into
the thoracic cavity through a
defect in the diaphragm after a
sudden increase in intra-
abdominal pressure. SDH is one
of the rarest surgical
emergencies with less than 30
reported cases in the literature.
References
• https://www.chop.edu/conditions-diseases/congenital-diaphragmatic-hernia-cdh
• https://radiopaedia.org/articles/bochdalek-hernia
• https://radiopaedia.org/articles/morgagni-hernia-2
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/congenital-diaphragmatic-
hernia#:~:text=Congenital%20diaphragmatic%20hernia%20(CDH)%20occurs,move%20into%20th
e%20chest%20cavity.
• https://patient.info/digestive-health/acid-reflux-and-oesophagitis/hiatus-
hernia#:~:text=Hiatus%20hernia%20is%20the%20term,a%20hiatus%20hernia%20develops%20sy
mptoms.
• https://www.healthline.com/health/diaphragmatic-
hernia#:~:text=An%20acquired%20diaphragmatic%20hernia%20(ADH,accidental%20damage%20t
o%20your%20diaphragm.
• https://pubmed.ncbi.nlm.nih.gov/30083643/#:~:text=A%20spontaneous%20diaphragmatic%20he
rnia%20(SDH,reported%20cases%20in%20the%20literature.