History of congenital diaphragmatic hernia in a newborn. Treatment of diaphragmatic hernia
Many children suffer from hernias, which is very dangerous if the child is an infant. Diaphragmatic hernia in newborns is rarely diagnosed, but it can threaten the life of a little person if measures are not taken in time.
With this disease, organs move from the abdominal cavity to the thoracic cavity. This affects the activity of the entire organism. Due to the hernia, the newborn has low weight and developmental delays. Organs from the peritoneum move to the chest area through a pathological or natural hole in the diaphragm. The wider the hernial opening, the more organs get into it, which leads to worsening blood circulation and breathing.
Development of the disease
Pathology begins to develop in the fourth week of pregnancy. When the muscles in certain places of the diaphragm stop developing, a hernia forms.
Experts determine the severity of the condition using several factors. First of all, they pay attention to the volume of organs that have moved into the chest. The movement is accompanied by malformations of the heart, lungs, nervous system, kidneys and gastrointestinal tract.
If a newborn pulmonary failure, then even surgery cannot improve his condition.
Diaphragmatic hernia in children has several types:
- diaphragmatic-pleural, which can be true or false;
- parasternal periosternal - classified as true;
- hiatal hernias are also classified as true.
Most often, diaphragmatic-pleural hernias and esophageal openings appear.
Symptoms
Birth is most likely to be premature if the newborn has a disease. If it is small in size, then there are no symptoms.
Diaphragmatic hernia in children is sometimes on the left side, so it affects the position of the heart. If you take an x-ray, you can see that most of it is on the right side. This effect is called dextrocardia.
- Due to asphyxia, the activity of the heart muscle may deteriorate. The pulse accelerates.
- Another sign is a sunken stomach. During breathing, retraction of the epigastric part is observed.
- Newborns with this malformation have underdeveloped lungs, as they are compressed by the abdominal organs. Breathing is accompanied by intestinal peristaltic sounds.
- The child's weight decreases as he refuses to eat and blood circulation is impaired.
- If the hernia strongly compresses the mediastinum, venous flow to the heart is disrupted. This leads to arterial hypotension.
- An electrocardiogram may show myocardial hypoxia.
The occurrence of anemia, pneumonia, and intestinal hemorrhage cannot be ruled out.
Reasons
Experts identify various prerequisites for the occurrence of the disease, although completely this disease not studied. No doctor can name the exact cause of the disease. Among the main reasons are:
As a result, the process of laying the fetal organs is disrupted. This provokes abnormal development diaphragm.
Diaphragmatic hernias can occur not only on the right or left side, sometimes they appear on both sides. This arrangement leads to the death of the newborn.
Diagnostics
Congenital diaphragmatic hernia in babies it is detected before birth thanks to ultrasound. Diagnosis is carried out from 22 to 24 weeks of pregnancy. The expectant mother has 
polyhydramnios. It occurs due to a bend in the fetal esophagus. The bend occurs due to the displacement of organs, as a result of which the swallowing process is disrupted amniotic fluid.
During pregnancy, ultrasound examinations are required. With their help, doctors monitor the growth of the fetus and the presence of deviations from the norm. If you identify the problem in time, there will be more opportunities for prevention. undesirable consequences and deaths.
One of the symptoms is the absence of a gastric gas bubble in the abdominal cavity. The occurrence of dropsy is possible, as venous edema develops. This disease must be controlled ultrasound examinations. During diagnosis, an amniotic sac is punctured to obtain a sample. amniotic fluid and analyze them.
If the diagnosis is made, then a consultation is assembled, which includes a perinatologist, a pediatric surgeon, a resuscitator and an obstetrician. They must determine what the prognosis is further development illness, find a way for delivery and think about treatment options.
Treatment
To treat the baby, fetoscopic correction is performed in utero. If the child’s life is at risk, a balloon is inserted into his trachea, which promotes lung development. This procedure has its own side effects. Artificial stimulation lungs can 
lead to rupture of the diaphragm, or it will form very weak. As for the mother, she faces difficult premature birth.
Diaphragmatic hernia in newborns can only be eliminated surgically. If the operation is performed on time, the chances of life will be high. The disease is not always identified before birth. To clarify the diagnosis, the newborn is given an x-ray. This examination makes it possible to detect clearings that have irregular shape. It is practically impossible to distinguish the diaphragmatic dome.
Specialists should exclude:
- intracranial hemorrhage;
- lung cyst;
- breathing problems;
- heart defects;
- atelectasis;
- esophageal atresia;
- liver tumor.
The newborn should be immediately ventilated and undergo surgery. It is carried out in two stages. Specialists will have to secure the hole in the diaphragm. A special synthetic material is sewn into the fabric of the hole. It will be removed after some time.
Adverse consequences often develop after surgery. Among them:
- pneumonia, edema, pleurisy;
- fever, breathing problems;
- intestinal obstruction;
- promotion inside abdominal pressure.
To eliminate and prevent complications, you should follow the recommendations of specialists and follow the diet that is always prescribed in such cases. After the operation, the newborn is transferred to prolonged artificial ventilation.
Diseases digestive system are very common, but their typical symptoms do not always indicate a problem with this particular group of organs. Ailments often arise due to a violation of the elasticity or integrity of the thin muscular septum - the diaphragm, as a result of which the formation hernia formations. This disease is dangerous, especially if left unattended and without medical assistance. It is very important to know about the main symptoms and manifestations of a diaphragmatic hernia in order to go to the hospital in time and prevent serious consequences.
Description
The diaphragm itself is a respiratory muscular plate, the topography of which allows it to clearly distinguish the thoracic and abdominal cavities of the human body. When it comes to a hernia, this means that organs or parts thereof emerge from the abdominal cavity through a hole in the diaphragmatic plate into the chest cavity. The main danger of this condition is that the hole can shrink, thereby pinching the organs passing through it, and without timely medical care this will lead to extremely disastrous consequences.
Diaphragmatic hernia is dangerous disease, requiring immediate medical careThe complications and consequences of such a disease are quite dangerous, the easiest of them is the development of an inflammatory process in the esophageal tube.
Types of diaphragmatic hernias
There are many classifications within which types of diaphragmatic hernias are distinguished according to different signs.
Depending on the nature of the displacement of the abdominal organs, sliding and paraesophageal Depending on the nature of the displacement of the abdominal organs, we can talk about the following types:
- sliding or axial - through a hole in the diaphragm, the abdominal organs and their elements can freely penetrate into the chest and, under certain circumstances, return back;
- paraesophageal - part of the stomach moves into chest area, being located as if parallel to the esophageal tube;
- mixed type.
Based on the differences in the location of the hernial orifice, there are:
- parasternal hernia (located close to the sternum);
- retrosternal (the gate is located behind the sternum);
- retrocostosternal (the gate of such a hernia is Larrey’s triangle, the junction of the sternal and costal parts diaphragmatic septum, there are no muscles here, only a thin plate of connective tissue).
Depending on the location of the area of organ protrusion:
- left-sided (in addition to the stomach, a thin and large intestine, liver or spleen);
- right-sided (affects the liver and part of the large intestine);
- bilateral hernia (the most complex cases).
Depending on what exactly was the impetus for the emergence of such a serious problem, there are two large groups Diaphragmatic hernias: traumatic and non-traumatic.
Post-traumatic
This group is directly related to the events that led to mechanical damage diaphragm. It could be injuries various kinds, falls from a height, injury due to compression of the body during an accident, etc. Often in such situations, several organs are damaged as a result of serious injuries, which requires emergency assistance to save lives.
Within this group we can talk about the following subtypes of the disease:
- acute hernia – prolapse occurs immediately after injury;
- chronic form - symptoms occur during eating, less intense than with acute form, and such a hernia is not diagnosed immediately;
- strangulated hernias are rare; their appearance is accompanied by sudden painful sensations in the abdomen and chest area.
Non-traumatic
The second group includes hernias, the appearance of which is associated with features and disturbances in the structure of the organ. Within its framework, we can talk about the following subtypes of the disease:
- congenital form (sometimes called false). Caused by violation normal processes fetal development, due to which the communication between the abdominal cavity and the sternum does not completely close;
- hernias of weak zones. They are considered true and develop in those areas where the diaphragm is thinnest and most vulnerable, in its so-called “weak areas”. Their peculiarity is that there is no hole as such, but the organs protrude abnormally due to the weakness of the plate, that is, an internal sac is formed;
- neuropathic, occurring against the background of abnormal relaxation of the muscle plate;
- damage to the natural holes of the plate. In this case, hernias form where there are normal openings in the diaphragm, for example, for the passage of the aorta.
Specialist's note: the most common hernia is considered to be in the area of the esophageal opening - it is diagnosed in 9 out of 10 cases. This phenomenon implies a displacement of the abdominal part of the esophageal tube and part of the stomach into the chest space. IN in rare cases Other organs that are normally localized in the abdominal cavity may be subject to such displacement.
Causes
Doctors call it like a series physiological reasons the occurrence of a hernia, and a list of factors that create favorable conditions, a “platform” for the active development of the problem.
In children
Mechanisms of formation congenital pathology have not been fully established, so it is difficult to name exact reasons. Under the influence of certain factors during the movement of the intestines into abdominal cavity and the formation of the diaphragm plate (from the 10th to 12th weeks of pregnancy), a failure occurs, due to which the muscle plate does not completely fuse. The frequency of diagnosing a birth defect of this kind is one case per 3 thousand newborns.
Video about diaphragmatic hernia in newborns
In adults
In adults provoke similar condition can specific situations, namely:
- high pressure in the abdominal cavity for a long time (this may be caused by chronic constipation, regular heavy lifting, strong in chronic diseases respiratory system);
- age factor - this problem is much more often diagnosed in patients over 50 years of age;
- abdominal injuries, falls or accidents;
- development chronic diseases digestive system.
Symptoms of the disease
When a baby with a congenital hernia is born, he begins to actively breathe and cry. The intestinal loops quickly fill with air, pressure in the body cavities increases and a condition called respiratory distress syndrome, usually this happens immediately after birth. Clinical manifestations depend on the size of the defect:
- if the hole is small, then the baby’s well-being does not deteriorate, the problem does not make itself felt for a long time until it develops to serious proportions;
- As the pathology grows, a feeling of squeezing appears in the chest cavity, chest and abdominal pain, and belching after eating;
- if the defect is large at birth, symptoms appear almost immediately - the stomach sinks, the chest swells, shortness of breath and obstruction appear.
In adult patients symptomatic manifestations partly different:
- an unpleasant sensation similar to heartburn, the intensity of which increases significantly when the body is tilted forward;
- eating is difficult, since after swallowing there is a feeling of a lump stuck in the esophagus;
- constant belching;
- bloating;
- painful sensations in the lower ribs, the intensity of which can vary greatly depending on the position of the body.
Diagnostics
Modern diagnostic methods help to establish the presence and degree of development of the problem even while the baby is in the womb. Different approaches can be used for children and adults.
| Age period | Current diagnostic methods | Description |
Intrauterine development | Ultrasound | The problem can be found on regular ultrasound fetus if the hernia is large enough. Diagnosis is possible after the end of the first trimester of pregnancy. |
Magnetic resonance imaging | If during an ultrasound there is a suspicion of the development of a hernia (due to noticeable displacement of organs), then the mother may be prescribed an MRI scan to obtain a clearer picture. |
|
Diagnosis in children and adults | X-ray examination | On the overview x-ray In the chest and abdominal cavities, both the atypical protrusion of the diaphragm and the hernia itself can be clearly visible. |
pH-metry | This method necessary to determine the current level of acidity in the elements of the digestive system. If the esophagus is marked increased level, then this is a suspicion of diaphragmatic hernia. |
|
| FEGDS | The patient needs to swallow a special tube with a camera, thanks to which it is possible to study current state mucous membrane. |
Treatment
In children
The congenital form requires only one treatment method - surgery (laparoscopy).
Doctor's advice: do not be afraid and refuse surgery for your baby, since the sooner the defect is eliminated, the less likely there are dangerous complications.
During the operation, surgeons place organs in correct position, setting them back through the opening of the diaphragm, and the defect itself is sutured to avoid worsening the situation and further development of the disease. If complications remain after the hernia, they are treated with medication.
Diaphragmatic hernia in the fetus If a child’s hernia was discovered at the stage intrauterine development, expectant mother transferred to a regime of constant medical supervision. This is due to the fact that with such a diagnosis there is a fairly high risk fatal outcome. If the baby has acute respiratory failure Due to the malposition of the organs, an emergency caesarean section is required for the operation.
Today, doctors practice intrauterine treatment of diaphragmatic hernias - the uterus is opened, and after the problem is eliminated, the child is carried further. This approach is a modern alternative that avoids caesarean section on early stages.
In adults
Treatment is complex and includes the prescription of medications, correction of the nutritional system, as well as surgical intervention.
Drug therapy
Prescribing medications is necessary to eliminate the symptoms of the disease and prevent the development of complications. The doctor can prescribe anti-inflammatory drugs, drugs to reduce acidity, painkillers, etc. Treatment always begins with a conservative approach; surgery is prescribed only if it is ineffective and the situation worsens.
Diet
The diet helps improve the general condition of diaphragmatic hernia, reduce heartburn, belching and discomfort in the stomach. Nutrition adjustments include the following:
- the volumes of food consumed should be small so as not to burden the digestive organs;
- You can drink drinks only an hour before meals or one and a half hours after meals;
- alcoholic, carbonated and artificial drinks should be excluded from the diet;
- products should be easily digestible, these can be: corn grits, dietary meat, steamed food, oatmeal etc.;
- should be added to your daily diet dates, nuts, figs or dried apricots;
- You need to chew food thoroughly - the eating process should take place slowly;
- After eating, you need to wait some time, at least an hour, before going to bed.
Prohibited foods for diaphragmatic hernia (photo gallery)
Bakery products 
Apples
Visceral massage
Within complex treatment For non-strangulated hernias, so-called visceral massage can also be used. The impact on the abdominal area is carried out through tapping and intense pressure. It is very important that the procedure is carried out by a professional, in which case it will improve general condition body, blood circulation in the abdominal cavity is normalized, and displaced organs will fall into place. This method is used as a temporary method to alleviate the condition and prevent strangulation before surgery.
Laparoscopy
The intra-abdominal segment of the esophagus lengthens, which leads to a decrease in the size of the hiatal hernia The operation is indicated if the formation is large in size or there is infringement of organs that are located in the hernial sac or passed through the opening of the diaphragmatic plate into the chest cavity. The essence of the operation is excision of the internal sac or suturing of the defect (hole) with preliminary repositioning of the organs in their places. If the hole is very large, then the technique of applying a “patch” made of special materials of synthetic origin can be used.
Folk remedies
Folk remedies for this disease can also be used, but only as a supplement to traditional treatment. They help suppress some symptoms: reduce the intensity of reflux, heartburn, and also normalize the digestive process. The most effective are the following recipes:
- goat milk is one of the most popular and effective means. It is consumed warm every day, half a glass in the morning and evening after meals;
- herbal decoction made from leaves peppermint, coltsfoot, dandelion, cinquefoil herb, shanta and angelica root. All elements are mixed in equal proportions (one hundred grams of each). To prepare the decoction, add one tablespoon to two glasses of water, and then simmer over low heat for five minutes. After cooling, the decoction is drunk for 30 days, one glass daily;
- alcohol tincture of propolis. To relieve heartburn you will need daily intake 15 drops of tincture mixed with sugar or a small amount of water;
- cumin seed tea. To make it, grind one tablespoon of cumin grains, then pour 200 ml of boiling water over them and leave to brew for five minutes. It is important to close the cup or other container with the mixture with a lid so that the composition is well infused. The tea should be taken warm and in small sips, which will significantly reduce nausea, vomiting and heartburn.
Effective folk remedies for diaphragmatic hernia (gallery)
Cumin seed tea 
It is quite possible to cope with a diaphragmatic hernia, all you need is integrated approach and patient compliance with all doctor’s recommendations. The main thing is to detect the problem in time and prevent complications from developing.
Diaphragmatic hernia in newborns is a pathological condition in which abdominal organs protrude into the chest through a hole in the diaphragm, which should not normally occur. It is a rare developmental defect found in 5 newborns out of 1000. The process of formation of a hernial orifice begins 3-4 weeks after conception, when a septum is formed between the thoracic and abdominal cavities. Underdevelopment of the muscle tissue of the diaphragm contributes to the appearance of the defect.
Reasons
The exact causes of diaphragmatic hernias are not clear. Provoking factors include:
- smoking, drinking alcohol and drugs during pregnancy;
- complicated pregnancy;
- exacerbation of severe chronic pathologies liver, kidneys, heart and lungs during pregnancy;
- severe course of the labor period;
- hard work physical labor in early pregnancy;
- reception medicines, providing negative impact on fetal development;
- passing x-ray examination in the first weeks of intrauterine development of the fetus;
- penetration of toxic substances into the body of a pregnant woman;
- consequences of chest injuries and abdominal area in newborns;
- chronic diseases of the respiratory system, causing prolonged coughing attacks.
Symptoms
Small hernias do not have typical symptoms, which makes diagnosis difficult. The appearance of secondary pathologies associated with impaired blood circulation in the internal organs, deficiency of surfactant (a substance that triggers the breathing process after cutting the umbilical cord) and blood poisoning is possible. With large sizes of hernial protrusion, signs associated with displacement appear internal organs and impaired gas exchange in the body. Clinical picture diaphragmatic hernia includes:
- Inability to open the lungs in the first minutes of life. The child has normal appearance, however, due to the lack of the ability to breathe independently, he does not make his first cry.
- Cyanosis (blue color) skin). At early appearance This symptom and the rapid increase in its intensity, the death of the child can occur in the first hours after birth. The risk of death is reduced when late appearance cyanosis and its weak expression.
- Attacks of suffocation. Occurs during breastfeeding. The child's skin becomes bluish, he begins to cough and choke. Additional muscles are involved in the breathing process. Signs of asphyxia disappear if the child is held in vertical position or lay on the side closest to the location of the protrusion.
- Cough. Does not apply to specific symptoms diaphragmatic hernias, however, it is observed quite often. Has a lingering dry character.
- Attacks of vomiting. Occurs when hernias cause displacement of the gastrointestinal tract organs.
- Signs of heart failure. In the first days, cardiac activity remains normal, but against the background frequent attacks asphyxia develops tachycardia.
- Dextrocardia. This is the name for a pathological condition in which part of the heart moves into right side. Right side the chest protrudes, the mobility of the affected side decreases. Left side sinks.
- Underdevelopment of lung tissue. Accompanied by frequent stoppages of breathing. Signs of pathology appear after cutting the umbilical cord, which starts the functioning of the lungs. These include rapid shallow breathing movements, bloating, decreased heart rate, bluish skin of the nasolabial triangle, and weakened sucking reflex. When inhaling, dry wheezing occurs behind the sternum and rumbling in the stomach.
- Increasing the duration of the respiratory pause. Promotes the emergence oxygen starvation, leading to death.
- Low weight. In the first month after birth, the baby’s weight not only does not grow, but also falls. The child refuses to breastfeed, develops anemia, and intestinal bleeding And inflammatory processes in the lungs.
Diagnostics
Prenatal diagnostics are carried out in the first days of life. Ultrasound and magnetic resonance imaging are used for this. Procedures help to detect indirect signs of pathology:
- Deviation of amniotic fluid volume from the norm. Due to compression of the esophagus and upper stomach, the fetus cannot swallow amniotic fluid.
- Displacement of parts of the stomach small intestine or gallbladder towards the chest.
- Peristaltic loops of intestine containing fluid. Found on the left side of the chest.
- Absence of the stomach at its anatomical location. Refers to additional diagnostic symptoms hiatal hernia.
- Relocation of the gallbladder to pleural cavity. Accompanied by displacement of the liver to the upper abdomen.
- Changes in the position of the heart and mediastinum. Occurs due to pressure caused by a large hernia.
- Signs of accumulation excess liquid in the skull and testicles. Development of these pathological conditions promotes venous stagnation.
Classification
Congenital
Among the hernias of this group are:
- True protrusions. They develop against the background of weakening and sagging of the muscles of the dome of the diaphragm, caused by a sharp increase in abdominal pressure. Organs fall out through holes located in the sternum and lower back. The cavity of the hernial sac contains intestinal loops, the greater omentum and abdominal tissue.
- False. The formation of such a protrusion is facilitated by aplasia (absence) of some parts of the diaphragm. In this case, communications arise between the thoracic and abdominal regions.
- Atypical. Such hernias are rarely diagnosed. They are distinguished from other malformations of internal organs by the presence of a characteristic hernial opening.
Traumatic
Such protrusions are formed against the background of the consequences of closed or open injuries sternum, accompanied by prolapse of internal organs through the resulting defect. A hernia forms at the time of injury or several months after it. Traumatic hernias most often have a left-sided nature, the hernial gap runs across the border between muscles and tendons.
In this case, the hernial sac is absent, so the protrusion is considered false. The tumor cavity contains parts of the stomach and intestines, liver and gall bladder.
Neuropathic
This form of the disease develops against the background of relaxation of the diaphragmatic muscles. The emergence pathological changes promotes disruption of innervation caused by inflammation nerve endings, damage to the brain and respiratory organs.
Esophageal hiatus diaphragm
A hiatal hernia is the most common type of congenital protrusion.
It is characterized by the movement of abdominal organs behind the sternum.
Has progressive chronic course. Appears in the background pathological expansion esophageal opening.
Treatment
A diaphragmatic hernia can only be cured through surgery. Several methods are used in surgery, the choice of which depends on the stage of fetal development.
Surgeries are performed both before and after birth. Transporting a newborn with congenital hernia may cause difficulties, therefore, if a defect is detected during intrauterine development, childbirth is carried out in perinatal center. The operation begins immediately after the birth of the child.
Intrauterine
This intervention is carried out in the 2nd trimester of pregnancy. The instruments are inserted through a small puncture in the wall of the uterus. IN respiratory tract A device is inserted into the fetus to help open the lungs. After birth, the balloon is removed.
Fetoscopic intervention is prescribed in the presence of defects incompatible with life.
However, even correct execution surgery does not guarantee a 100% chance of survival. Intervention may provoke premature birth or lead to respiratory injury.
In a baby
When the diaphragm ruptures or organs are compressed preparatory stage excluded. The operation includes the following steps:
- Artificial creation of anterior hernia abdominal wall by endoscopy. Indicated for a pronounced decrease in the volume of the abdominal cavity, which prevents the organs from returning to their normal position.
- Elimination of artificial protrusion. The second stage of the operation is scheduled 7-365 days after the first. During the intervention, the hernial opening is closed, and the pleural cavity is washed.
Forecast
Survival depends on the size of diaphragmatic hernias in children. The prognosis is influenced by the presence of concomitant defects and the time of the start of the operation. If intrauterine correction is refused, 40-75% of children survive. When attempting fetal correction, the probability of fetal death is 60%. 7% of newborns die in the first hours of life.
Complications
With a diaphragmatic hernia, the following complications may develop:
- Duodeno-gastric reflux. It is characterized by the constant entry of gastric and intestinal contents into the esophagus.
- Inflammation of the mucous membranes of the esophagus. This consequence is typical sliding hernias, accompanied by a hit gastric juice into the upper parts of the digestive system.
- elimination of chronic diseases in pregnant women;
- reducing the risk of intrauterine infection of the fetus through early vaccination.
During pregnancy, it is necessary to regularly visit an obstetrician-gynecologist and undergo an ultrasound examination.
Contents of the article
Congenital diaphragmatic hernia- movement of abdominal organs into the chest through a congenital defect in the diaphragm.Prevalence of diaphragmatic hernias
Diaphragmatic hernias are common with an incidence of 1:2000 to 1:4000 among newborns.Embryopathogenesis of diaphragmatic hernias
The defect is formed at the 4th week of embryo development when the membrane forms between the pericardial cavity and the abdominal cavity of the embryo. Stopping the development of individual muscles in certain areas of the diaphragm leads to the development of hernias with a hernial sac, the walls of which consist of serous membranes- abdominal and pleural leaves. This is how real hernias are formed. In case of false hernias, through a through hole in the diaphragm, the abdominal organs, not covered by the hernial sac, move into the chest without restrictions, which leads to the development of intrathoracic tension syndrome. Among false hernias, Bogdalek's hernia is the most common - movement of abdominal organs into the chest cavity through a posterior parietal defect in the diaphragm, which looks like a gap. With diaphragmatic hernias, the severity of the child's condition is determined not only by the volume of organs that have moved, but also by defects. Quite often, these children have pulmonary hypoplasia of varying severity, heart defects, defects of the central nervous system and gastrointestinal tract. Congenital diaphragmatic hernias occur especially severely in children with lung deficiencies, as well as prompt elimination diaphragmatic hernia does not improve their condition.Classification of diaphragmatic hernias
By origin and location, diaphragmatic hernias are divided as follows:1. Congenital diaphragmatic hernia:
a) phrenic-pleural (real and false);
b) pairs asternalni (real);
c) phrenopericardial (real);
d) hiatal hernia (real).
2. Acquired hernias are traumatic (false).
Most often in children, diaphragmatic-pleural hernias occur, as well as hiatal hernias.
Diaphragmatic Hernia Clinic
In the clinical manifestations of diaphragmatic hernia, two symptom complexes can be distinguished:1. Cardiopulmonary disorders accompanied by intrathoracic tension syndrome - with diaphragmatic-pleural hernias.
2. Gastroesophageal reflux - with hiatal hernia. With a significant volume of organs, they have moved into the chest, clinical manifestations respiratory failure manifests itself early. After birth or within a few hours, shortness of breath and cyanosis develop. Acute respiratory failure progresses rapidly. On examination, attention is drawn to the asymmetry of the chest (with protrusion on the affected side) and a sunken abdomen. Sometimes peristaltic sounds can be heard by auscultation in the chest on the affected side. For small hernias clinical symptoms not very pronounced. With hiatal hernias, clinical manifestations are associated with dysfunction of the gastric cardia and manifest themselves in the form of gastroesophageal reflux (reflux esophagitis).
