The diaphragm is a muscle that serves as a partition between the thoracic and abdominal cavity. It also has vital role in respiration. There are two diaphragms each on either side of chest. It separates the lungs, heart from organs of abdomen. Between the diaphragms there is an orifice through which the food pipe, aorta and inferior vena cava passes. The orifice is tightly sealed under normal circumstances. Any type of weakness either congenital or acquired in the orifice can result in protrusion of abdominal organs into the chest cavity. This defect is called diaphragmatic hernia.
Symptoms of diaphragmatic hernia include breathing difficulty, increased breathing rate, cyanosis, bowel sound in chest, etc. This condition can occur in anyone including children and adults. Diaphragmatic hernia is a serious condition. Patient requires urgent surgery to place abdominal organs in abdominal cavity and the orifice is repaired and sealed properly.
Common Causes Of Diaphragmatic Hernia
Diaphragmatic hernia is a condition in which the abdominal content moves upwards into the thoracic cavity through the tiny hole between the two diaphragms. There are two types of diaphragmatic hernia; congenital or acquired. Congenital diaphragmatic hernia occurs when the fetus is developing in the womb. The defect in the diaphragm causes abdominal organ to move upwards due to pressure in the abdomen. The organ congests the thoracic cavity and prevents proper growth of lung. Congenital diaphragmatic hernia is since birth but it is rarely familial in origin.
Acquired hernia mainly develops in adults and it usually occurs due to traumatic injury. Penetrating injury to the lower chest and high impact injuries on abdomen may result in rupture of diaphragm. This may make way for the abdominal content to enter into the chest cavity. Diaphragmatic hernia can also occur as a complication of abdominal or chest surgery.
Majority of congenital diaphragmatic hernia have no known cause. However, it is believed that genetic abnormality, nutritional deficiency or environmental exposure may result in this defect during the early embryonic development. In case of acquired hernia, the most probable risk factor is trauma, either with blunt instrument or sharp object in chest and abdomen.
Signs And Symptoms Of Diaphragmatic Hernia
The symptoms of diaphragmatic hernia may occur over a period of time or may develop instantly depending on the size, cause and organ involved. The symptoms are as follows:
- Heartburn and belching with increase in frequency is a sign of diaphragmatic hernia. Patient feels burning sensation in middle of chest and below the sternum. Patient may also complain of frequent hiccups.
- Chest pain is commonly observed in adults having diaphragmatic hernia. It occurs as a result of inflammation of diaphragm. It is caused by passage of part or stomach or any other abdominal content through the hole in the chest cavity. Chest pain is severe and sometimes it mimics like a heart attack.
- Swallowing difficulty in adults is established symptom of diaphragmatic hernia. This may be caused due to irritation in the esophagus. Patient may also complain of loss of appetite and nausea.
- Respiratory distress and cough.
- Intestinal obstruction.
- Pain in abdomen.
All the above symptoms are common in adults.
In infants diaphragmatic hernia may produce symptoms such as:
- Difficulty in breathing.
- Blue discoloration of skin, tongue and nails.
- Rapid heartbeats.
- One side of chest may be more developed as compared to other.
- Caved in abdomen.
- Bowel sound in chest
Diagnosis And Treatment Of Diaphragmatic Hernia
Diaphragmatic hernia in infants can be diagnosed before the baby is born during the sonogram examination that is performed in pregnancy. After birth the defect can be diagnosed with symptoms and medical tests. Medical tests for children as well as adults include X-ray of chest and abdomen, ultrasound examination, CT scan, MRI of thorax.
Congenital and acquired diaphragmatic hernias are serious condition. They need to be treated urgently. Both needs surgical repair. Surgery is performed to place the abdominal organ in its actual anatomical location. Simultaneously the diaphragm is also repaired.
Surgery for congenital diaphragmatic hernia is usually performed within 72 hours after birth. However, this may sometimes vary depending on the health of the baby.