Diaphragmatic hernia

[Julene]

A diaphragmatic hernia is a hole or weakening in the diaphragm that allows some of the abdominal organs to protrude into the chest.

This defect causes severe difficulty breathing.
The diagnosis is based on prenatal ultrasonography or a chest x-ray.
The infant is given oxygen, and surgery is done to close the defect.

The diaphragm is the muscular sheath that separates the organs of the chest from those of the abdomen.
Diaphragmatic hernias occur on the left side of the body 85% of the time. The stomach, loops of intestine, and even the liver and spleen can protrude through the hernia. If the hernia is large, the lung on the affected side is usually incompletely developed. About half of children with diaphragmatic hernias also have heart defects, kidney defects, or chromosome disorders.
After delivery, as the newborn cries and breathes, the loops of intestine quickly fill with air. This rapidly enlarging structure pushes against the heart, compressing the other lung and causing severe difficulty breathing, often right after birth. Also, if the lung had been compressed a lot before birth, the blood vessels in the lung become narrowed, which causes high blood pressure in the lung arteries (persistent pulmonary hypertension). The high blood pressure does not let enough blood flow through the lungs, which limits the amount of oxygen in the bloodstream. Persistent pulmonary hypertension is the major cause of death among infants who are born with diaphragmatic hernia.
(See also Overview of Digestive Tract Birth Defects.)

[Renato]

Diaphragmatic hernia is protrusion of abdominal contents into the thorax through a defect in the diaphragm. Lung compression may cause persistent pulmonary hypertension. Diagnosis is by chest x-ray. Treatment is surgical repair.
(See also Overview of Congenital Gastrointestinal Anomalies.)
Diaphragmatic hernia usually occurs in the posterolateral portion of the diaphragm (Bochdalek hernia) in 95% of cases and is on the left side in 85% of cases; in 2% of cases it is bilateral. The estimated incidence is 1 to 4 in 10,000 live births. Anterior hernias (Morgagni hernia) are far less common (5% of cases). Other congenital anomalies are present in about 50% of cases, and adrenal insufficiency is relatively common.
Loops of small and large bowel, stomach, liver, and spleen may protrude into the hemithorax on the involved side. If the hernia is large and the amount of herniated abdominal contents is substantial, the lung on the affected side is hypoplastic. Other pulmonary consequences include underdevelopment of the pulmonary vasculature, resulting in an elevation of pulmonary vascular resistance and hence pulmonary hypertension. Persistent pulmonary hypertension leads to right-to-left shunting at the level of the foramen ovale or through a patent ductus arteriosus, which prevents adequate oxygenation even with oxygen supplementation or mechanical ventilation. Persistent pulmonary hypertension is the major cause of death among infants with congenital diaphragmatic hernia.