Definition
In a diaphragmatic hernia a condition occurs in which parts of the abdominal organs are displaced into the thoracic cavity. In general, a distinction must be made between so-called true diaphragmatic hernias and a diaphragmatic defect. The difference is that in a real diaphragmatic hernia the abdominal organs are surrounded by a hernia sac, whereas this is not the case in a diaphragmatic defect.
A diaphragmatic hernia is caused by a weak point in the diaphragm and can be congenital or occur during life (for example after an accident). There are a number of typical weak points where diaphragmatic hernias occur particularly frequently. A common example are hernias that find a way into the thoracic cavity through a gap in the back of the diaphragm.
This gap is also called the Bochdalek triangle. Hernias on the right diaphragm often pass through the so-called Morgagni hole, while the so-called Larrey’s cleft is the passageway on the left side of the diaphragm. Both gaps normally serve as a passageway for blood vessels. Even where the esophagus or the aorta passes through the diaphragm, parts of the abdominal organs can pass through the diaphragm and form a hernia.
Causes for the occurrence of diaphragmatic hernias
The causes for the occurrence of diaphragmatic hernias can be different. In general, a distinction must be made between a congenital and an acquired diaphragmatic hernia. Congenital hernias often occur due to a developmental disorder of the diaphragm.
If there is a disturbance in the diaphragmatic development of the child during pregnancy, abdominal organs may already be located in the chest cavity at birth (diaphragmatic hypertension). In most cases, the exact cause of the diaphragm’s maldevelopment is unclear. However, an increased probability for the occurrence of diaphragmatic hernias has been found for certain genetic defects.
Acquired diaphragmatic hernias can occur for a variety of reasons. Especially after serious accidents and injuries these hernias occur frequently. In many cases an individual weakness of the diaphragm together with other risk factors is responsible for the development of the hernia.
For example, hernia can develop when the abdominal pressure is increased, for example by tensing the abdominal muscles and strong “pressing” during defecation. Pregnancy and obesity can also increase the risk of developing a diaphragmatic hernia. If the diaphragm is injured by an accident or injuries such as stabbing or gunshot wounds, a resulting hernia is also possible.
Diaphragmatic hernias that occur in infants are also called congenital diaphragmatic hernias. These usually occur without an explainable cause. However, it has been shown that hernias in children with a genetic defect are somewhat more common than in children without a genetic defect.
As a rule, children with a congenital diaphragmatic hernia must be treated intensively after birth and be operated on as soon as possible. The prognosis of a congenital diaphragmatic hernia varies depending on the limitation of lung development and function. However, surgery that repositions the organs below the diaphragm and repairs the defect is often successful in children who have sufficient lung development.
The increased pressure in the abdomen of pregnant women can occasionally be the reason for a diaphragmatic hernia. Digestion usually suffers due to the limited space during pregnancy. However, whether a diaphragmatic hernia has developed can usually only be determined after pregnancy, when the body slowly returns to normal.
Since most diaphragmatic hernias are asymptomatic, some diaphragmatic hernias that developed during pregnancy are never diagnosed. However, if it causes discomfort, the hernia will be treated in the same way as any other hernia after pregnancy. Increased pressure in the abdominal cavity during pregnancy can cause not only a diaphragmatic hernia but also an umbilical hernia. You can read more about this in the next article: Umbilical hernia during pregnancy