A diaphragmatic hernia is a problematic opening or rupture in the diaphragm---the large, arc-shaped muscle separating the abdominal cavity from the chest cavity. The diaphragm plays an important role in keeping the heart and lungs in the chest and the stomach and intestines in the abdomen. The most common cause of a diaphragmatic hernia is a congenital birth defect, which affects roughly 1 out of every 5,000 children born, reports Medline Plus. Though this type of hernia in adults is rare, the most common cause of a diaphragmatic hernia in adults is a traumatic injury. Hernias are serious conditions that require intensive treatment.
Balloon Treatment
If a particularly severe diaphragmatic hernia is diagnosed before birth, doctors may begin treatment of the hernia before the child is born. One serious complication of a diaphragmatic hernia occurs when the stomach and intestines push through the hole in the diaphragm while the baby is still developing. If the intestines push on the lungs, they can prevent the lungs from developing properly in the baby, leading to severe respiratory difficulties. To prevent this, doctors may insert a small balloon in the baby's trachea during the second trimester. This balloon prevents fluids from being pushed out of the lungs by the intestines and helps the lungs to develop correctly, explains the University of Michigan Fetal Diagnosis and Treatment Center.
Assisted Breathing
When a baby is born with a diaphragmatic hernia, doctors carefully monitor the baby's breathing. Because the lungs may have been affected by the diaphragmatic hernia, the baby may need to be immediately placed in a extracorporeal membranous oxygenation system, abbreviated ECMO, which is a lung and heart bypass device that breathes for the baby and delivers oxygen to the blood, the Children's Hospital of Boston explains. In other cases, the baby may be placed in a mechanical ventilator to assist breathing. The baby will need to stay in intensive care for careful monitoring until he is stable enough to undergo surgery.
Organ Reposition Surgery
When the baby's condition has stabilized after birth, a doctor will need to perform surgery to repair the diaphragmatic hernia. Adults who develop a diaphragmatic hernia will also require surgery to repair the tear.The surgeon will make an incision just under the ribs. Then the surgeon must pull the stomach and intestines out of the chest cavity through the hole in the diaphragm, and position them back in the abdominal cavity. The surgeon will then repair the hole in the diaphragm, using stitches or sometimes a plastic patch. For a few days after the surgery, a tube may remain in the patient's chest to allow fluids and air to drain out, giving the lungs room to expand.
References
- Medline Plus: Diaphragmatic Hernia
- Medline Plus: Diaphragmatic Hernia Repair - Congenital
- Children's Hospital Boston: CDH Treatment
- The Children's Hospital of Philadelphia: Congenital Diaphragmatic Hernia (CDH)
- University of Michigan Health System - Fetal Diagnosis and Treatment Center: Congenital Diaphragmatic Hernia
