Types of Diaphragmatic Hernia in Adults: Causes, Symptoms, Treatment, Repair

By definition, a hernia is the unwanted protrusion of tissue which burst through a weakened spot on a cavity wall which was meant to separate them. This particular type involves the diaphragm.

What is a diaphragmatic hernia?

It is a sheet of internal skeletal muscle which extends over the thoracic, or chest, cavities. It’s the chamber which houses the lungs, heart, and parts of the esophagus, trachea, and thymus gland. Needless to say, it’s crucial and protects some of the most important organs in your body. In these hernias, contents of the abdomen, like intestines, from entering the chest area.

How common is diaphragmatic hernia in adults?

Luckily, diaphragmatic hernia in adults is rare. If they do occur, it is likely the product of a serious accident. Serious traumatic injuries or penetration to the region can result in diaphragmatic damage which may develop later into hernias.

For the most part, this malady forms before you’re out of the womb. It’s estimated about one out of every two thousand babies born suffers from this. In scarce occurrences, the condition may remain unnoticed until adulthood. Mostly, it’s detected during prenatal visits.

What are the diaphragmatic hernia types?

There are four main diaphragmatic hernia types. Hiatal, Iatrogenic, traumatic, and congenital. While the first refers to acquired instances, congenital means it occurs during the gestational period.

It can be broken down from there into two cases, Morgagni and Bochdalek hernias. The former involves malformation on the front part. The latter accounts for the back and sides. Separation of types is made considering location and origin.

Potential diaphragmatic hernia causes

In addition to this forceful injury, diaphragmatic hernia causes are often congenital. This term means it is something an individual is born with. In fact, one can often observe the diagnosis through ultrasounds of the afflicted fetus. This birth defect is a result of improper diaphragm development. The diaphragm forms between the seventh and tenth week of pregnancy. The timing is simultaneous with the fetal development of the digestive organs. When the defective barrier designs to keep these in the belly is defective, they can move right up where they don’t belong. There are reasons why we don’t want a liver below our ribcage. This displacement can hinder the formation of other vital sections. The origin of this phenomena is believed to be multifactorial, meaning, the combination of several factors is responsible for causing this. Both genetic and environmental components are suspect. Scientists have found that a fifth of patients also have chromosome problems. Comorbid diagnoses can impact the life expectancy of the baby. Overall survival rate of kids experiencing the anomaly is about 65 percent.

Which diaphragmatic hernia symptoms will one experience?

Every case is different, but there are some diaphragmatic hernia symptoms which are more prevalent than others. It is impossible to conduct an interview in newborn kids. Discomfort and sharp pain in the region are to be expected. For infants, their distress is clear and it is generally thought early on. For adult onset patients, imaging protocols following an injury can often catch damages which may cause issues later. Respiratory difficulties (irregular breathing), heightened heartbeat, cyanosis (turning blue), or visual deformities are expected.

In one particularly rarity, a 27 year old female reported having epigastric pains for four days in addition to dyspepsia (indigestion). It caused her to vomit repeatably, however, initial physical examination and blood tests yielded nothing worth investigation. A radiograph carried out following the lack of success revealed air fluid level on the left side of her chest. After fasting and having her stomach decompressed via nasogastric tube aspiration, a computed tomography (CT) uncovered the herniation of her stomach, small intestines, and splenic flexure of the large bowel. She was successfully treated but claimed to have not experienced any reason for it’s triggering. Prior medical records provided evidence she had no problems two years before.

What is diaphragmatic hernia repair surgery?

A diaphragmatic hernia repair surgery consists of putting the organs back where they belong and reconstructing the damaged barrier. The patient will be administered anesthesia and will remain unconscious throughout the experiment. There are several approaches a surgeon may take depending on the severity, health of the child, and location. These may be conducted in open air or by using a small camera (laparoscope).

Both are effective, but laparoscopy allows the procedure to be carried out without an excessive incision or exposing your entrails to the world. The repair recovery time will vary between cases. Newborns will be committed to the neonatal intensive care unit (NICU) as the condition is life threatening. Discuss surgery cost with your health care provider, insurance company, and advisors from the hospital.

Other kinds of diaphragmatic hernia treatment

In addition to the surgery, the nurses and doctors may recommend another diaphragmatic hernia treatment in the meantime to manage their health and prevent organ failure. To help a baby unable to breathe, mechanical ventilation may be instituted. The ventilator will mechanically assist breathing by applying pressure systematically to the chest and suctions over the mouth and stomach may be placed to remove fluids building up in there. Extra corporeal membrane oxygenation (ECMO) refers to a temperate bypass machine. It delivers oxygen to the bloodstream and performs circulation.

 

 

Article References:

  1. https://www.stanfordchildrens.org/en/topic/default?id=diaphragmatic-hernia-90-P02357
  2. https://www.cdc.gov/ncbddd/birthdefects/diaphragmatichernia.html
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015605/
  4. https://jamanetwork.com/journals/jamasurgery/article-abstract/558958
  5. http://www.cdhgenetics.com/congential-diaphragmatic-hernia.cfm

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