Diaphragmatic Hernia is caused when there is a defect in the diaphragm and the contents of the stomach migrate up into the chest and thereby compressing the lungs and causing difficulty in breathing etc.
What is Diaphragmatic Hernia?
The diaphragm is a muscular sheet which separates the lungs from the contents of the abdomen.The main function of this sheet is to help in respiration.Just like the plunger in a syringe,the diaphragm moves down during breathing and creates a negative suction pressure in the chest.This action sucks the air from the atmosphere into the lungs.
Due to various reasons this muscular sheet can have a defect or a hole.Through this hole the contents of the abdominal cavity can migrate up into the chest and lie there.This causes compression of the lungs on that side, thereby preventing its effective expansion and breathing.This condition is referred to as diaphragmatic hernia.
Causes of Diaphragmatic Hernia
A diaphragmatic hernia is an uncommon condition. Most commonly the defect occurs because of a developmental problem when the child is in the womb of the mother. The children are born with this defect. Many times, this is diagnosed immediately after birth when the hernia is large and the child develops breathing difficulty. Sometimes this problem can go unnoticed till adulthood when it is diagnosed by an X-ray done routinely for some other problem.
This problem can also arise due to other reasons like trauma, obesity and as a result of some surgeries.
What are the Symptoms of Diaphragmatic Hernia?
The most common symptom is difficulty in breathing. This can occur during rest when the hernia is very big. In moderate size hernias the patient might experience breathing difficulty during exertion like running or climbing stairs.
Babies born with large hernia can have severe breathing problems after birth and may be needed to be kept on artificial breathing support on a ventilator.
Sometimes when the intestines which have migrated into the chest can get twisted and this can cause intestinal obstruction causing vomiting and inability to pass stools. This is a serious life threatening emergency.
What are the Complications of Diaphragmatic Hernia?
When there is a defect or hole in the diaphragm, the respiratory movement is not very effective. And through this hole the intestines can start slowly migrating up from the tummy into the chest.
As more and more intestines move into the chest cavity. The lungs in the chest does not have enough space to expand because the chest cavity gets occupied with intestines gradually.
This is the reason that the diaphragmatic hernia generally presents with respiratory complications. Patients come with breathlessness complaining about gradually increasing difficulty in breathing. And when we do a scan or X ray we find a large diaphragmatic hernia.
Types of Diaphragmatic Hernia
There are two types of diaphragmatic hernia, one is Congenital diaphragmatic hernia and the second is acquired diaphragmatic hernia.
Congenital meaning by birth there is an incomplete formation diaphragm. Therefore, there is a defect in that and the intestines are already present in the chest and it needs to be repaired early.
Acquired diaphragmatic hernia develops during the course of life. Through this defect intestines migrate into chest cavity over time.
How is Diaphragmatic Hernia Treated?
Small diaphragmatic hernias which don’t cause any symptoms do not require any treatment. Large symptomatic hernias need repair. In most cases this repair is done laparoscopically. A mesh is usually placed to cover the defect and the hernia is repaired. The recovery time after laparoscopic hernia repair is usually very short and patients are back to their normal activities in a week.
Laparoscopic Surgery for Diaphragmatic Hernia
Like any other hernia medical treatment does not work for diaphragmatic hernia. The treatment has to be surgical.
With the advent of laparoscopic techniques, the treatment is much simpler these days. The patient undergoes a laparoscopic not a keyhole operation during which the hole in the diaphragm is sutured and it is reinforced with a composite dual layered mesh and thereby a future recurrence of hernia is prevented. The recovery time is very fast. Generally diaphragmatic hernia repair patients go back from the hospital within a day or two and within a week they are able to resume all their normal daily activities.