Congenital diaphragmatic hernia

Congenital diaphragmatic hernia. With this developmental malformation, the intra-abdominal organs move into the thoracic cavity through a defect in the diaphragm. Distinguish between true and false hernias of the diaphragm itself. With true hernias there is a hernial sac, the wall of which is a thin section of the diaphragm that is devoid of muscle fibers. With false hernias, the hernial sac is absent. Neonates also have diaphragm relaxation, resulting from damage to the diaphragmatic nerve during delivery.

Hernias of the esophageal opening of the diaphragm relatively rarely manifest themselves in the period of newborn, but in severe cases there are pronounced symptoms of gastroesophageal reflux, usually causing peptic esophagitis and aspiration pneumonia, which leads the child to a state of hypotrophy.

Symptoms of diaphragmatic hernia (especially false) appear immediately after birth; Their occurrence is associated with the development of the syndrome of intrathoracic tension. Characteristic of dyspnea, common cyanosis, retraction of intercostal spaces, tachycardia. When examined, note the sunken stomach, some increase in the volume of the chest, often asymmetric. Depending on the degree of filling of the intestine with gases, a boxed hint of percussion sound or its shortening is detected. Respiratory noises are not heard. Due to the fact that the false and true hernia of the diaphragm is mainly left-sided localization, the heart is shifted to the right and tones are better heard over the right side of the thorax. Sometimes peristaltic sounds of the intestine can be heard above the surface of the chest, sharply increasing after feeding.

A review X-ray study with the introduction of a probe into the stomach allows you to diagnose. On the roentgenogram, cellular shadows in one of the halves of the chest are defined, formed by the loops of the intestine. The heart is biased in the opposite direction. Pulmonary pattern on the side of the lesion is not determined. Differential diagnosis is performed with congenital localized emphysema, lung kyotami. When in doubt, resort to the study of the gastrointestinal tract with a contrast agent. The latter is injected through the catheter into the stomach or performed by irrigography.

In cases of relaxation of the diaphragm during fluoroscopy, its high standing is noted. The diaphragm is revealed in the form of a clear, high-placed arcuate line. Mark its paradoxical movements associated with loss of tone.

Treatment. If there is a marked syndrome of intra-thoracic tension, an emergency operation is indicated. Affordable hernias are laparotomic. After the removal of the organs moved from the thoracic cavity to the abdominal cavity, the plastic of the defect of the diaphragm is produced. With true diaphragmatic hernia, especially right-sided, transthoracic access is more convenient.

When performing surgery, it must be remembered that diaphragmatic hernia can be accompanied by an incomplete bowel turn. The prognosis depends on the degree of hypoplasia of the lungs, the severity of hypertension in a small circle of circulation, the presence of other developmental defects, and the timeliness of the operation.