Diaphragmatic hernia. Why does a newborn develop a diaphragmatic hernia and can it be cured? Ultrasound signs of fetal diaphragmatic hernia

Diseases digestive system very common, but not always typical symptoms for them indicate a problem with this particular group of organs. Ailments often occur due to a violation of the elasticity or integrity of the thin muscular septa - the diaphragm, as a result of which hernial formations are formed. This disease is dangerous, especially if it is left without attention and medical care is not provided. 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 muscle plate, the topography of which allows it to clearly distinguish between the chest and abdominal cavities of the human body. When it comes to a hernia, this means that organs or parts of them come out of 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 assistance this will lead to extremely disastrous consequences.

Diaphragmatic hernia is dangerous disease requiring immediate medical care

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 varieties of diaphragmatic hernias are distinguished according to various criteria.

Depending on the nature of the displacement of organs abdominal cavity distinguish 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 the 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 to the chest region, while being located, as it were, parallel to the esophageal tube;
mixed type.

Based on the differences in the location of the hernial ring, 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 the Larrey triangle, the junction of the sternal and costal parts of the diaphragmatic septum, there are no muscles here, only a thin plate of connective tissue).

Depending on the location of the area of protrusion of organs:

left-sided (in addition to the stomach, the small and large intestines, liver or spleen can protrude);
right-sided (affects the liver and part of the large intestine);
bilateral hernia (the most difficult cases).

Depending on what exactly was the impetus for such a serious problem, there are two large groups diaphragmatic hernia: traumatic and non-traumatic.

Post-traumatic

This group is directly related to the events that led to mechanical damage diaphragm. These can be injuries of various kinds, falls from a height, damage due to squeezing the body during an accident, etc. Often in such situations, as a result of serious injuries, several organs suffer at once, which requires emergency care 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 meals, are less intense than with acute form, and such a hernia is not diagnosed immediately;
strangulated hernias are rare, their appearance is accompanied by sharp pain in the abdomen and chest.

Non-traumatic

The second group includes hernias, the appearance of which is associated with features and disorders in the structure of the organ. Within its framework, we can talk about such subspecies of the disease:

congenital form (sometimes called false). It is caused by a violation of the normal processes of fetal development, due to which the communication between the abdominal cavity and the sternum does not completely overgrow;
hernias of weak zones. They are considered true and develop in those areas where the diaphragm is the 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, arising against the background of abnormal relaxation of the muscle plate;
damage to the natural openings of the plate. Hernias in this case are formed where there are normal holes in the diaphragm, for example, for the passage of the aorta.

Specialist note: the most common is a hernia in the area esophageal opening- 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 rare cases, other organs localized in the normal state in the abdominal cavity may be subjected to such a displacement.

Causes

Doctors call like a number physiological reasons the occurrence of a hernia, as well as a list of factors that create favorable conditions, a “platform” for the active development of the problem.

In children

Formation mechanisms congenital pathology not fully established, so it is difficult to name the exact reasons. Under the influence of certain factors, during the movement of the intestine into the abdominal cavity and the formation of the diaphragm plate (from the 10th to the 12th week of pregnancy), a failure occurs, due to which the muscle plate does not completely grow together. Diagnosis frequency birth defect of this kind - one case per 3 thousand newborns.

Video about diaphragmatic hernia in newborns

In adults

In adults, specific situations can provoke a similar condition, namely:

high pressure in the abdominal cavity for a long time (this can be caused by chronic constipation, regular weight lifting, severe in chronic diseases respiratory system);
age factor - this problem is much more often diagnosed in patients over the age of 50;
injuries in the abdomen, 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, the pressure in the body cavities increases and a condition develops called respiratory distress syndrome usually occurs 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 worsen, the problem does not make itself felt for a long time until it develops to a serious scale;
as the pathology grows, a feeling of squeezing appears in chest cavity, pain in the chest and abdomen, and belching after eating;
in the event that already at birth the defect is large, symptoms appear almost immediately - the stomach sinks, the chest swells, shortness of breath and obstruction appear.

In adult patients, symptomatic manifestations partially differ:

an unpleasant sensation similar to heartburn, the intensity of which increases significantly when the body is tilted forward;
eating is difficult, because after swallowing there is a feeling of a lump stuck in the esophagus;
constant belching;
bloating;
pain at the bottom of the 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 detected on a routine fetal ultrasound if the hernia is large enough. Diagnosis is possible at the end of the first trimester of pregnancy.
	Magnetic resonance imaging	In the event that during the ultrasound there is a suspicion of the development of a hernia (due to a noticeable displacement of the organs), then the mother may be assigned an MRI study to obtain a clearer picture.
Diagnosis in children and adults	X-ray examination	On the overview x-ray chest and abdominal cavities can be clearly seen as an atypical protrusion of the diaphragm, and the hernial formation itself.
	pH meter	This method necessary to determine the current level of acidity in the elements of the digestive system. If the esophagus is marked elevated level, then this is a suspicion of a diaphragmatic hernia.
	FEGDS	The patient needs to swallow a special tube with a camera, thanks to which it is possible to study the current state of the mucosa.

Treatment

In children

The congenital form implies only one method of treatment - surgery (laparoscopy).

Doctor's advice: do not be afraid and refuse the operation for the baby, since the sooner the defect is eliminated, the less the likelihood of dangerous complications.

During the operation, surgeons place the organs in the correct position, pushing them back through the opening of the diaphragm, and the defect itself is sutured to avoid worsening the situation and further development illness. If there are complications after a hernia, then they are treated with medication.

Diaphragmatic hernia in the fetus

If a hernia in a child was detected even at the stage of intrauterine development, the expectant mother is transferred to the regime of constant medical supervision. This is due to the fact that with such a diagnosis there is a rather high risk of death. In the event that the baby has an acute respiratory failure due to wrong location organs, an urgent caesarean section is required for the operation.

Today, doctors practice intrauterine treatment of diaphragmatic hernias - an opening of the uterus is performed, and after the problem is eliminated, the child is born further. This approach is a modern alternative to avoid caesarean section on the early dates.

In adults

The treatment is complex and includes the prescription of medications, correction of the nutrition system, as well as surgical intervention.

Medical therapy

The appointment of 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 the level of acidity, painkillers, etc. Treatment is always started with a conservative approach, the operation is prescribed only if it is ineffective and the situation worsens.

Diet

The diet helps to improve the general condition with diaphragmatic hernia, reduce heartburn, belching and discomfort in the region of the stomach. Power adjustments include the following:

the amount of food consumed should be small so as not to load the digestive organs;
drinks can be drunk only an hour before a meal or one and a half after a meal;
alcoholic, carbonated and artificial drinks should be excluded from the diet;
foods 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 carefully - the process of eating should take place slowly;
after eating, you must wait for some time, at least an hour, before going to bed.

Prohibited foods for diaphragmatic hernia (photo gallery)

Bakery products Apples

Visceral massage

As part of complex treatment for incarcerated hernias, the so-called visceral massage can also be used. The impact on the abdomen is carried out by tapping and intense pressure. It is very important that the procedure is carried out by a professional, in which case it will improve general state body, blood circulation in the abdominal cavity is normalized, and the displaced organs will fall into place. This method is used as a temporary method to alleviate the condition and prevent infringement 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 or there has been an infringement of the organs that are located in the hernial sac or have passed through the opening of the diaphragmatic plate into the chest cavity. The essence of the operation is the excision of the inner sac or the suturing of the defect (hole) with the preliminary reduction of the organs in their place. If the hole is very large, then the technique of applying a "patch" from special materials of synthetic origin can be used.

Folk remedies

Folk remedies for this disease can also be used, but only as an addition to traditional treatment. They contribute to the suppression of some symptoms: they reduce the intensity of the manifestation 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 used every day warm form half a glass in the morning and evening after meals;
herbal decoction made from peppermint leaves, coltsfoot, dandelion, cinquefoil herb, chantha and angelica root. All elements are mixed in equal proportions (one hundred grams of each). To prepare a decoction, one tablespoon should be poured with two glasses of water, and then boiled 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 a daily intake of 15 drops of tincture mixed with sugar or a small amount of water;
cumin seed tea. To make it, grind one tablespoon of cumin seeds, then pour them with 200 ml of boiling water 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. Tea should be taken warm 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, only an integrated approach is needed and the patient's compliance with all the doctor's recommendations. The main thing is to detect the problem in time and prevent the development of complications.

congenital diaphragmatic hernia- This is a disease in which the abdominal organs (usually the stomach and intestines) move up through the gap in the diaphragm and compress the lungs and heart.

Information Diaphragmatic hernia occurs quite often: 1 case per 2000 - 4000 newborns. Isolated diaphragmatic hernia, according to most studies, is more common in boys (male to female ratio of approximately 1.5:1).

In 50% of cases there are concomitant malformations gastrointestinal tract, kidney, heart, central nervous system. Diaphragmatic hernia can also be one of the components of hereditary chromosomal diseases, such as:

(trisomy on the 21st pair of chromosomes);
(trisomy on the 18th pair of chromosomes);
(trisomy on the 13th pair of chromosomes).

The reasons

The defect begins to form at the 4th week of pregnancy, when a septum is formed between the pericardial cavity (the location of the heart and lungs of the embryo) and its trunk. The following factors can provoke its development:

(it penetrates through the mother's blood to the cells of the fetus and damages its cells);
Narcotic substances very quickly penetrate into the cell and damage its genetic apparatus;
Exposure to ionizing radiation;
Reception medicines that have a teratogenic effect on the fetus (cytostatics, some antibiotics);
Harmful working conditions (work with chemicals);
Unfavorable environmental conditions in the place of residence.

With underdevelopment of muscles in certain parts of the diaphragm, true hernias, that is, the abdominal organs are covered with a thin serous membrane - a hernial sac. With the complete absence of the muscular layer of the diaphragm and unlimited movement internal organs talking about diaphragm relaxation.

If the hole in the diaphragm is through, then they talk about false hernias– organs penetrating through this gap are not covered by anything. They usually put the most pressure on the lungs and heart, since the movement of the intestines and stomach is unrestricted.

According to the location of the hernial opening, there are:

Diaphragmatic-pleural hernias are more common than others and are located mainly on the left. There are true and false;
Parasternal hernias are located behind the sternum and are only true;
Hernias of the esophageal opening of the diaphragm are also only true.

Symptoms

The severity of clinical manifestations directly depends on the type of hernia and the degree of compression of the internal organs.

Additionally For diaphragmatic-pleural hernia especially large sizes when almost the entire intestine moves, signs of acute respiratory failure are characteristic.

Shortness of breath, cyanosis appear immediately after birth or after a while. The cry of the child is not loud, as the lungs cannot fully open. The skin and mucous membranes are bluish in color. The condition of the newborn is rapidly deteriorating. On examination, in addition to cyanosis, the asymmetry of the chest is striking with a protrusion on the side of the lesion (usually on the left) and with the lack of movement of this half of the chest. The baby's belly is sunken.

With small hernias, the symptoms are less pronounced, difficulty breathing and shortness of breath are more often observed while feeding the baby, when changing his position. Sometimes deterioration can occur in children of preschool and even school age. When the stomach wall is infringed in the hernial opening, children begin to complain of abdominal pain, nausea, and reflex vomiting may occur.

With parasternal hernia the symptoms are not pronounced and they are not constantly detected. Children may complain of abdominal pain, nausea, and vomiting. Respiratory problems are very rare.

For hiatal hernia the most characteristic signs of gastroesophageal reflux - children often spit up, they have difficulty swallowing, they do not gain weight well.

Diagnostics

A large diaphragmatic hernia can be detected already in the second half of pregnancy, when the compression of the lungs by the intestines is clearly visible. If the hole is small, symptoms may appear immediately after birth or later. To clarify the diagnosis, an x-ray of the abdominal organs is taken - and the picture shows the movement of intestinal loops.

Diaphragmatic hernia treatment

At acute disorder breathing, first of all, with the help of a special probe, gas is removed from the stomach in order to reduce the degree of compression of the lungs. Then the baby is transferred to artificial ventilation of the lungs. After the main vital signs are normalized, surgical correction of the diaphragm defect is performed.

AT last years methods of intrauterine treatment of diaphragmatic hernias are being developed. The lungs of the fetus constantly produce fluid that exits through the trachea into the amniotic cavity. With artificial blockage of the trachea, the lungs stretch and grow, gradually forcing the hernial contents back into the abdominal cavity. This operation is performed either in an "open" way, requiring an opening of the uterus, or with the help of special equipment through a small (5 mm) incision in it. As an additional treatment, corticosteroid hormones are used, which accelerate the maturation of the lungs.

Forecast

The prognosis depends on the size of the defect, concomitant malformations and the quality of medical care.

Congenital diaphragmatic hernia in a baby is a serious pathology in which organs that are normally located in the abdominal cavity move upward through a gap in the diaphragm. Most often, the intestines and stomach are moved, but other options are possible. The incorrect position of the organs leads to compression of the lungs and heart and disruption of their work.

Such a pathology occurs relatively often - in one newborn out of 2-4 thousand. An isolated hernia is more often diagnosed in boys than in girls, the ratio is approximately 1.5: 1. In about half of the cases, a hernia is combined with other organ malformations.

This defect is formed at the very beginning of the development of the embryo, from about the 4th week. At this stage, a membrane is laid between the peritoneum and the pericardium. If suddenly the development of muscle structures is suspended or disrupted, a hernia may develop with a hernial sac formed from the serous membranes of the abdominal and pleural sheets.

This is how a true hernia is formed, and a false one is obtained when organs that are not covered with a bag penetrate the chest through a through diaphragmatic opening. This leads to intrathoracic tension syndrome. The most common of these is Bogdalek's hernia.

Often, true diaphragmatic hernias are one of the manifestations of chromosomal pathologies, including trisomy syndromes, Edwards and Patau.

To provoke a violation of the formation of the diaphragm and the development of a hernia are capable of:

Ethanol exposure and narcotic substances;
Smoking during pregnancy;
Negative influence harmful substances from environment at work or as a result of living in ecologically unfavorable regions;
Taking drugs with a teratogenic effect;
Exposure of the embryo to ionizing radiation.

Symptoms

The clinical manifestations of the pathology depend on its type and degree of squeezing of the organs. According to the location of the hole, all diaphragmatic hernias are divided into:

Diaphragmatic-pleural. They are predominantly on the left, can be both true and false. Such hernias are very big size, and may miss the entire intestine, resulting in acute respiratory failure.
Parasternal. They are only true and are located behind the sternum.
Hernia of the esophageal opening. They are also only true.

A child with a diaphragmatic-pleural hernia immediately after birth or after some time develops shortness of breath and cyanosis. Such babies cry quietly, as the lungs do not fully open. In most cases, there is a sharp deterioration in the condition of the baby. On examination, asymmetry of the chest can be seen. On the side of the lesion, a protrusion is observed, while the tummy looks sunken.

If the hernia is small, the symptoms will be less pronounced - breathing problems will appear only during the feeding of the child and when changing the position of the body. Sometimes small hernias go unnoticed and appear in preschool or even school age. Sometimes the first sign is abdominal pain, nausea and vomiting, caused by the infringement of the stomach wall in the opening of the hernia.

The symptoms of a parasternal hernia are not very pronounced, and they do not appear constantly. Sometimes children have nausea and vomiting, abdominal pain is noticeable. Respiration remains normal in most cases.

With hiatal hernia in babies, gastroesophageal reflux is observed. They often spit up and swallow with difficulty, so they do not gain weight well. In a few weeks, the baby can not only not gain a single gram of weight, but also lose weight. In addition, they have:

lack of appetite;
anemia;
pneumonia;
hemorrhages in the intestine.

Diagnostics

If the hernia is large enough, it can be detected by ultrasound in late pregnancy. In such a situation, the doctor will see compression of the lung by the intestines on the monitor screen. It is also often observed in women carrying babies with a hernia. Due to the kink in the esophagus, the baby in the womb cannot swallow the amniotic fluid, so there is too much of it.

If the hole is small, symptoms may be detected after birth or even much later. X-ray of the abdominal cavity organs will help to make an accurate diagnosis, usually displaced bowel loops are clearly visible in the pictures.

Sometimes the intestines can be found in the projection of the cardiac chambers. Also, a symptom of a hernia is the absence of a gas bubble of the stomach in the abdominal cavity and the detection of the gallbladder in the pleural cavity. Due to obstructed venous outflow, dropsy is often diagnosed in the fetus.

It is very important to carry out differential diagnosis with pathologies such as:

Tumors of the mediastinum;
Bronchogenic cysts;
Adenomatous cystic transformation of the lungs.

If a hernia is suspected in the perinatal period, an amniocentesis may be needed to collect amniotic fluid. The amount of specific pulmonary surfactants in the amniotic fluid will determine the level of their production and the condition of the organ.

If a hernia of the diaphragm is diagnosed before the birth of a child, a council is necessarily convened, which determines how viable the fetus is and what treatment it will need. In particular difficult situations doctors may recommend artificial termination of pregnancy.

Treatment

The only treatment for a diaphragmatic hernia is surgery. If necessary, the operation can be performed even during pregnancy at 26-28 weeks. The essence of the procedure is that a special balloon is inserted through a small hole into the trachea of the fetus, which stimulates the development of the lungs of the embryo. Later, it is removed, and the second operation can be performed both before childbirth and after them.

Intrauterine operations are performed only in cases where the baby is doomed without them. But even a qualitatively carried out correction gives only a 50% chance of recovery.

If immediately after birth, the baby is diagnosed with asphyxial infringement or diaphragmatic rupture, the operation is performed urgently. In other cases, the intervention can be slightly delayed. Unfortunately, after surgery, complications develop in about 50% of cases.

Forecast

The prognosis for this pathology depends on the size of the defect and the presence of concomitant defects. Also important is the quality and timeliness of the assistance provided. More or less accurate predictions can only be given by doctors after a thorough examination.

The content of the article

congenital diaphragmatic hernia- movement of the abdominal organs into the chest through a congenital defect in the diaphragm.

The prevalence of diaphragmatic hernias

Diaphragmatic hernias are common with a frequency of 1:2000 to 1:4000 among newborns.

Embryopathogenesis of diaphragmatic hernias

The defect is formed at the 4th week of embryo development when a membrane is formed 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. Thus, real hernias are formed. With false hernias, through a through hole in the diaphragm, the abdominal organs that are not covered with a hernial sac move into the chest without restrictions, which leads to the development of intrathoracic tension syndrome. Among false hernias, Bogdalek's hernia is more common - the movement of the abdominal organs into the chest cavity through the posterior parietal defect in the diaphragm, which looks like a gap. With diaphragmatic hernias, the severity of the child's condition is due not only to the volume of organs that have moved, but also to defects. Quite often, these children have lung hypoplasia of varying severity, heart defects, defects of the central nervous system and gastrointestinal tract. Particularly severe congenital diaphragmatic hernia occurs in children with lung deficiencies, and surgical removal of diaphragmatic hernia does not improve their condition.

Classification of diaphragmatic hernias

By origin and localization, diaphragmatic hernias are divided as follows:
1. Congenital diaphragmatic hernia:
a) diaphragmatic-pleural (true and false);
b) pairs of asternal (real);
c) frenopericardial (real);
d) hiatal hernia (real).
2. Acquired hernias - traumatic (false).
Most often in children there are diaphragmatic-pleural hernias, as well as hernias of the esophageal opening of the diaphragm.

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 hernia of the esophageal opening of the diaphragm. With a significant volume of organs that have moved to the chest, clinical manifestations of respiratory failure appear early. After birth or within a few hours, shortness of breath, cyanosis develops. Acute respiratory failure progresses rapidly. On examination, attention is drawn to the asymmetry of the chest (with a protrusion on the side of the lesion) and a sunken abdomen. Sometimes peristaltic noises can be heard auscultatively in the chest on the side of the lesion. With small hernias, the clinical symptoms are not very pronounced. With hernias of the esophageal opening of the diaphragm, clinical manifestations are associated with impaired function of the cardia of the stomach and manifest as gastroesophageal reflux (reflux esophagitis).

Diagnosis of diaphragmatic hernias

Diagnosis of diaphragmatic hernia should be carried out even during prenatal examination of the fetus by ultrasound (the presence of intestinal loops or other organs - the stomach, spleen, liver, displaced into the chest cavity of the fetus). diaphragmatic-pleural hernias of the chest cavity, intestinal loops are observed in the form of a spotted pattern with areas of significant enlightenment (gas in the intestines). The heart and mediastinal organs are displaced in the opposite direction, the lungs are collapsed. When contrasting the gastrointestinal tract with a barium mixture, the contrast mass fills the sections of the intestines of the chest cavity. The radiological picture of hiatal hernias depends on their shape. With paraesophageal hernias - the chest cavity turns out to be formations with a liquid level, while the gas bubble of the stomach in the abdominal cavity is reduced or absent. A contrast study reveals an hourglass-shaped stomach, the upper section of which is observed in the thoracic cavity, and the lower section in the abdominal cavity. Ultrasound can reveal a displacement of the abdominal organs (in particular the liver) in pleural cavity.

Diaphragmatic hernia treatment

Treatment of diaphragmatic hernias is surgical with long (but not more than 24-48 hours) preoperative preparation.Principles surgical treatment consist in moving the abdominal organs from the chest to the abdominal cavity, suturing or plasty of a diaphragm defect in case of false hernias and defect plasty in case of real ones (possibly using plastic materials). AT postoperative period the child should be on prolonged mechanical ventilation. Adverse Consequences after surgery can be in 30-50% of children.

Diaphragmatic hernia prognosis

The prognosis depends on the severity of the child's condition and the severity of congenital lung damage (their hypoplasia).

In newborns, it is congenital. An anomaly of development is a concomitant disease in pathologies of the gastrointestinal tract, kidneys, cardiovascular and central nervous systems. A rare ailment is associated with a change in the natural position of the abdominal organs. The stomach, esophagus, intestines with diaphragmatic hernia in young children are shifted to the chest area.

Features of the development of the disease

The anomaly begins to actively develop even during the gestation of the fetus. At the 2nd month of pregnancy, the formation of a natural barrier between the organs of the abdominal cavity and connective tissue hearts. At this point, in some cases, there is a violation of muscle contraction, the formation of a hernial sac, resulting in an expansion of the esophageal opening of the diaphragm.

Through a rupture of the connecting membrane, the stomach can move into the chest area. The severity of the disease depends on the volume of the digestive system organs that have moved from the abdominal cavity, concomitant developmental anomalies: kidney failure, heart disease and nervous system, pathology of the intestinal tract.

Classification

The fetus may develop a diaphragmatic hernia of various forms: according to the time of occurrence, the presence of an enveloping film, the location and side of the location.

Time of occurrence:

congenital;
acquired.

The presence of an enveloping film:

true;
false.

Location:

diaphragmatic - pleural;
parasternal peristernal;
frenopericardial;
esophageal opening.

Location side:

left-sided;
right-sided.

The appearance of a hernial sac indicates the true form of pathology, the absence - a false variety. The enveloping film can be located in the peristernal, frenopericardial, pleural cavity, esophageal opening. With a false form in the baby, intrauterine movement of the organs of the digestive system occurs. In newborns, a left-sided hernia is more common, but a rupture can also be observed in the right side of the diaphragm.

Causes

Pathology develops due to genetic mutations of the embryo on initial period formation of internal organs in the womb. The causes of the congenital form of diaphragmatic hernia are:

severe pregnancy;
early toxicosis;
malfunctions of the gastrointestinal tract in a pregnant woman: impaired stool, bloating;
transferred viral, infectious, colds during pregnancy;
the use of alcohol, tobacco products, drugs in the early stages;
diseases of the respiratory system of a chronic form;
long-term use of toxic medications during childbearing;
emotional overstrain, frequent exposure to stressful situations;
negative impact of environmental factors: ecology, harmful chemical emissions at work, radiation.

The congenital true or false type of the disease is associated with the presence in the mother internal pathologies the nature of the pregnancy.

The acquired form of diaphragmatic hernia is due to frequent constipation in an infant, constant strong crying, screaming. As a result, there is a weakening of the tone of the respiratory muscle, an increase in intra-abdominal pressure.

Manifestations of pathology

Malformation of intrauterine development is accompanied by other anomalies associated with the functioning of the vital important organs newborn. This is due to the displacement of the stomach, esophagus, which leads to pressure on the lungs, heart. Symptoms of a congenital or acquired form of diaphragmatic hernia do not depend on the presence of a bag, the place where the connective membrane is ruptured. Signs of pathology after the birth of a child are basic and common.

Main:

vomit;
nausea;
silent crying;
cough;
asymmetric arrangement of the chest;
shortness of breath, shortness of breath;
rapid pulse.

low body weight;
pale color skin;
decreased appetite;
excretion of vomit, stool with impurities of blood;
pathology of the cardiovascular, respiratory system.

The main sign of the formation of a diaphragmatic hernia in children is cyanosis - pallor of the skin. The disease is associated with insufficient blood oxygen saturation. When the connecting membrane ruptures, the baby suffocates, does not swallow enough air. Lack of oxygen can lead to lethal outcome. A serious complication of diaphragmatic hernia due to protrusion of the organs of the digestive system is a change in the position of the heart muscle, which leads to asymmetry of the chest, retraction of the abdomen.

The symptomatology of the disease is affected by the size of the hernial sac, the location of the protruding organs of the digestive tract, and concomitant malformations of the child. Indirect signs indicate dysfunction, the presence of inflammatory processes, VDG.

With the defeat of the esophageal opening, belching, regurgitation after feeding, difficult swallowing of food can be observed. With parasternal parasternal form of hernia appear pain sensation in the abdomen, nausea, but no breathing problems.

Diagnosis of a malformation

It is possible to establish the formation of a hernia in the early stages of pregnancy. During the entire period of gestation future mom undergoes an ultrasound examination, the results of which show intrauterine development baby. A sign of the pathology of the diaphragm is polyhydramnios in a pregnant woman and the displacement of the heart, liver, impaired venous outflow in a child.

If a malformation is suspected, amniotic fluid is taken by puncturing the amniotic membrane of the fetus to conduct laboratory research. To examine the organs of the abdominal, thoracic cavity, as prescribed by the attending physician, magnetic resonance imaging can be performed. After the birth of the baby, an x-ray is prescribed to exclude serious illnesses: internal hemorrhages in the brain, cysts, malformations of the cardiovascular and respiratory systems, cancerous neoplasms, tumors.

Hernia Treatment Methods

If the pathology is detected during gestation, then the treatment of diaphragmatic hernia involves intrauterine surgery. The operation is performed at the permitted period - 26-28 weeks of pregnancy. The task of surgical treatment of a diaphragmatic hernia in a baby is the introduction of a balloon through the incised uterus into the fetal trachea to stimulate the work of the respiratory system organ, to expel the enveloping film. The device is removed during labor activity. Intrauterine surgery is prescribed only for severe pathology.

If a pathology is detected after the birth of a child, surgical intervention is prescribed before the baby reaches 1 year. Emergency hospitalization is carried out with internal bleeding, infringement of a hernia.

During the operation, the protruding organs are moved into an artificially created bag, and then the rupture of the respiratory muscle is repaired some time after the first stage surgical intervention. After the procedure, the child may experience dangerous complications:

inflammation, pulmonary edema;
obstruction of food through the intestines;
dehydration;
fever.

Possible serious consequences occur after the removal of the parasternal form of hernia. After the operation, the child's lungs are artificially ventilated. To avoid recurrence of the pathology, the doctor prescribes a diet, breastfeeding baby.

Prevention measures

To avoid intrauterine anomalies in the development of the fetus, it is necessary to plan pregnancy in advance, follow the recommendations during the period of bearing a child. Before conception, a woman needs to go through comprehensive examination, pass laboratory tests, drink a course of vitamin and mineral preparations, lead a healthy lifestyle.

The main rules in early pregnancy are:

avoidance of stress, mental and physical strain;
physical exercises: yoga, breathing exercises;
quitting smoking, drinking alcohol, drugs;
active lifestyle: correct, balanced diet, regular walks outdoors.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor medical sciences. Prescribes diagnostics and conducts treatment. Study Group Expert inflammatory diseases. Author of more than 300 scientific papers.