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Infant diaphragmatic hernia
Infant diaphragmatic hernia


Diaphragmatic hernia repair - series
Diaphragmatic hernia repair - series


Diaphragmatic hernia

Definition:

A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm. The diaphragm is the muscle between the chest and abdomen that helps you breathe. The opening allows part of the organs from the belly (stomach, spleen, liver, and intestines) to go up into the chest cavity near the lungs.



Alternative Names:

Hernia - diaphragmatic; Congenital hernia of the diaphragm



Causes:

A diaphragmatic hernia is a rare defect that occurs while the baby is developing in the womb. The abdominal organs, such as the stomach, small intestine, spleen, part of the liver, and the kidney, may take up part of the chest cavity. This prevents the lung from growing normally.

It is more common on the left side. Having a parent or sibling with the condition slightly increases your risk.



Symptoms:

Severe breathing problems almost always develop shortly after the baby is born. This is due in to poor movement of the diaphragm muscle crowding of the lung tissue. This causes the lung to collapse.

Other symptoms include:



Exams and Tests:

The pregnant mother may have a large amount of amniotic fluid. Fetal ultrasound may show abdominal organs in the chest cavity.

An exam of the infant shows:

  • Irregular chest movements
  • Lack of breath sounds on side with the hernia
  • Bowel sounds that are heard in the chest
  • Abdomen that feels less full when touched

A chest x-ray may show abdominal organs in chest cavity.



Treatment:

A diaphragmatic hernia repair is an emergency that requires surgery. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm.

The infant will need breathing support during the recovery period. Some infants are placed on a heart/lung bypass machine. This gives the lungs a chance to recover and expand after surgery.

If a diaphragmatic hernia is diagnosed during pregnancy (around 24 to 28 weeks), fetal surgery may be an option.



Outlook (Prognosis):

The outcome of surgery depends on how well the baby's lungs have developed. It also depends on whether there are any other congenital problems. Usually, the outlook is very good for infants who have enough lung tissue and have no other problems.

Medical advances have made it possible for 4 out of 5 infants with this condition to survive.



Possible Complications:
  • Lung infections
  • Other congenital problems


When to Contact a Medical Professional:

Go to the emergency room or call the local emergency number (such as 911). A diaphragmatic hernia is a surgical emergency.



Prevention:

There is no known prevention.



References:

Maheshwari A, Carlo WA. Diaphragmatic hernia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 95.

Keijzer R, Puri P. Congenital diaphragmatic hernia. Semin Pediatr Surg. 2010 Aug; 19(3):180-5.

Puri P, Nakazawa N. Congenital diaphragmatic hernia. In: Puri P, Hollworth M, eds. Pediatric surgery: diagnosis and management. Springer, 2009:chap 31.




Review Date: 6/9/2013
Reviewed By: Sameer Patel, MD, Assistant Professor of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Morristown Medical Center

100 Madison Avenue
Morristown, NJ 07960
973-971-5000

Overlook Medical Center

99 Beauvoir Avenue
Summit, NJ 07901
908-522-2000

Newton Medical Center

175 High Street
Newton, NJ 07860
973-383-2121

Chilton Medical Center

97 West Parkway
Pompton Plains, NJ 07444
973-831-5000

Goryeb Children's Hospital

100 Madison Avenue
Morristown, NJ 07960
973-971-5000

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