The diaphragm is a dome-shaped muscular barrier between the chest and the abdomen. It separates your heart and lungs from your abdominal organs (stomach, intestines, spleen, and liver).
A diaphragmatic hernia occurs when one of your abdominal organs moves upward into your chest through a defect (opening) in the diaphragm. This kind of defect can be congenital (present at birth) or acquired later in life. It is always a medical emergency and requires surgery to correct.
A congenital diaphragmatic hernia (CDH) is due to the abnormal development of the diaphragm while the fetus is forming. A defect in the baby’s diaphragm allows one or more of her abdominal organs to move into the chest and occupy the space where her lungs are supposed to be. As a result, the baby’s lungs are unable to develop properly. In the majority of cases, only one lung is affected.
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. Surgery on the abdomen or chest may also cause accidental damage to your diaphragm.
Most congenital diaphragmatic hernias are idiopathic; their cause is unknown. However, chromosomal abnormalities have been implicated in about 30 percent of cases.
The following factors may increase your risk of an acquired diaphragmatic hernia:
- blunt injuries due to a traffic accident
- surgical procedures on the chest or abdomen
- stab wounds
- gunshot wounds
The symptoms of a diaphragmatic hernia may vary depending on its cause and severity. The following signs and symptoms are significant in both a CDH and ADH:
This is usually very severe. In a CDH, it results from the abnormal development of the lungs. In an ADH, it occurs when the lungs cannot function properly.
Blue Discoloration of the Skin
When your body doesn’t receive enough oxygen from your lungs, it can make your skin appear blue.
Tachypnea (Rapid Breathing)
Your lungs may try to compensate for the low levels of oxygen in your body by working at a faster rate.
Tachycardia (Rapid Heart Rate)
Your heart may pump rapidly to try to supply your body with oxygenated blood.
Diminished or Absent Breath Sounds
This symptom is normally present in the case of a CDH because one of the baby’s lungs may not have formed properly. The breath sounds on the affected side will be absent or very difficult to hear.
Bowel Sounds in the Chest Area
This occurs when your intestines move up into your chest cavity.
Your abdomen may feel less full than it should upon palpation (an examination of the body by pressing on certain areas).
A congenital diaphragmatic hernia can usually be diagnosed before the baby is born. An ultrasound examination may reveal the abnormal position of the abdominal organs in the fetus. The pregnant mother may also have an increased amount of amniotic fluid (the fluid that surrounds and protects the fetus).
After birth, the following abnormalities may appear during a physical examination:
- abnormal chest movements
- difficulty breathing
- absent breath sounds on one side of the chest
- bowel sounds in chest
- a less full abdomen
The following tests are usually sufficient to diagnose both a CDH and an ADH:
- ultrasound scan: uses sounds waves to produce images of the thoracic and abdominal cavities and their contents
- CT scan: allows for direct viewing of the abdominal organs
- arterial blood gases (ABG): takes blood directly from an artery and tests for levels of oxygen, carbon dioxide, and acidity (pH level)
Both congenital and acquired diaphragmatic hernias are surgical emergencies. Surgery must be performed to remove the abdominal organs from the chest and place them back into the abdomen. The diaphragm must then be repaired.
The surgery is ideally performed 24 to 48 hours after the baby is born in the case of a CDH. The first step is to stabilize the baby and increase its oxygen levels. This can be achieved through endotracheal intubation; a tube is inserted into the mouth and down to the baby’s trachea (windpipe). The other side of the tube is connected to a mechanical ventilator (breathing machine). Once the baby stabilizes, surgery can be performed.
In an ADH, the patient may also need to be stabilized before surgery. Because most cases of ADH are due to injury, there might be other complications such as internal bleeding. Therefore, the surgery is usually performed as soon as possible.
The prognosis for a diaphragmatic hernia depends on how badly your lungs are damaged. According to the Johns Hopkins Children’s Center, the survival rate for CDH is more than 80 percent. The survival rate for an ADH correlates directly with the type of injury and its severity.
There is no way to prevent a CDH, but certain basic preventive measures can help you avoid an ADH:
- Drive safely.
- Avoid activities that make you prone to blunt injuries to the chest or abdomen, such as contact sports.
- Exercise caution around sharp objects, such as knives and scissors.