Diaphragmatic Hernia: Symptoms & Treatment

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

You may be familiar with the word 'hernia', but you may not be familiar with diaphragmatic hernia. In this lesson, we will learn about diaphragmatic hernias as well as symptoms and treatment associated with them.

What's Wrong With My Baby?

Janie is a 34-year-old female who arrives at the emergency department late one night, clearly in labor. She lives in a very rural area and although she looks nine months pregnant, she is unable to say how far along she is. She hasn't had prenatal care for her pregnancy and in fact this is the first time she has seen the doctor.

She is rushed to the labor and delivery department where the nurses and physicians hook her up to monitors and further assess her. Shortly after arriving, she delivers an eight pound baby girl.

Immediately after delivery, it is obvious the baby is in distress. Her lips are blue and she is breathing very rapidly. The baby is rushed to the neonatal intensive care unit (NICU) where a tube is placed into her lungs and a machine helps her to breathe. The doctor orders some tests and goes to tell Janie the diagnosis.

What is a Diaphragmatic Hernia?

The doctor explains to Janie that her baby girl has a diaphragmatic hernia. She has no idea what that is and quickly asks him to explain.

He tells her that the diaphragm is a muscle that separates the chest cavity from the abdominal cavity, and plays an important part in helping us breathe. A diaphragmatic hernia is an abnormal opening in the diaphragm, resulting in organs from the abdominal cavity being able to move into the chest cavity.

The diaphragm separated the upper chest cavity from the abdominal cavity. Abdominal organs can enter the chest cavity in the event of a diaphragmatic hernia.
chest cavity

There are two types of this hernia:

  • Congenital diaphragmatic hernias is a birth defect that occurs in the womb while the fetus is developing.
  • Acquired diaphragmatic hernias can occur later in life and are from some type of trauma that results in an opening in the diaphragm, as from stabbing or gunshots.

The doctor further explains that since this abnormal opening was present while the baby was developing, other organs were affected as well. The baby's intestines migrated into the chest cavity, which caused her lungs to not fully develop.

There are two types of diaphragmatic hernia:

  • Bochdalek hernia - the side and back of the diaphragm are affected, therefore the stomach, spleen, liver, and/or intestines can enter the chest cavity. This is by far the most common, responsible for about 90% of all cases.
  • Morgagni hernia - the front part of the diaphragm is affected, therefore the liver or intestines enter the chest cavity.

Symptoms of a Diaphragmatic Hernia

Diaphragmatic hernias are life-threatening. When the abdominal organs have moved into the chest cavity, it can cause the lungs to not develop properly.

Janie's baby showed classic symptoms of having a diaphragmatic hernia. She was clearly having difficulty breathing and was breathing very fast. Her heart rate was also rapid, as her body was trying to compensate for her lungs not being able to get enough oxygen to the body. Her blue appearance, also called cyanosis, is from a lack of oxygen.

When the doctor assessed the baby, Her abdomen was also oddly shallow and concave. He later understood this was from her intestines moving into her chest cavity.

The doctor ordered a chest x-ray to visualize the chest cavity. He also noticed she had an abnormal chest appearance and chest movements, so he ordered an MRI to closer evaluate. This is where he was able to confirm the diagnosis of diaphragmatic hernia and could see that the intestines were in the chest cavity. He could also see that one of her lungs was underdeveloped because of this.

How to Treat a Diaphragmatic Hernia

Janie's baby was rushed to the NICU, intubated and on a ventilator to help her breathe. The immediate need is to stabilize her breathing or she could die.

Surgery was scheduled the next morning to move her intestines back down into the abdominal cavity and repair the hole in the diaphragm. Surgery and repair is required in acquired diaphragmatic hernias as well.

Janie was thankful for all the care of her baby and wondered if she would have any further problems.

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