Diseases of Diaphragm Flashcards
Embroyolgic development of diaphragm
- 7-10th week of gestation
- Components:
- Septum transversum
- L/R pleuroperitoneal membranes
- Dorsal mesentary of esophagus
Congenital diaphragmatic hernia (CHD) frequency
Rare, 1 in every 2000-3000 live births
Decreased survival with CHD due to:
- Assocaited congenital abnormalities
- Prematurity
- Low birth weight
MC timing of detection of CHD
In utero (by prenatal ultrasound)
Bochdalek hernia
posterolateral CHD
- MC CHD (90%)
- Males (3:2)
- Left-sided (80-90%)
- Associated defects:
- Cardiac
- Renal
- Neural
- GI
MC CHD
Bochdalek hernia (90% of all CHD)
- Left sided
- Males (3:2)
- Associated defects:
- Cardiac
- Renal
- Neural
- GI
Major co-morbid state assocaited with CHD
Pulmonary hypoplasia and pulmonary HTN
- Due to early herniation and entrapment of abdominal orangs in chest with lung compression (directly on ipsilateral side, indirectly due to compression on contralateral side)
- Respiratory impairment
- May require ECMO
- Feeding problems
- Growth retardation
CXR finding with CHD
Intestinal loops or tip of orogastric tube in chest
Moratality rate associated with Bochdalek hernia
~ 50%
Surgical repair technique for Bochdalek hernia
- Approach from abdomen
- Reduction of hernia contents
- Resection of hernia sac (present in 20% of cases)
- Closure or reconstruction (non-absorbable mesh) of defect
- Resection of extralobar sequestration if present at time of hernia repair if patient stable
Morgagni hernia
Anterior defect
- Between xiphoid and costochondral attachments of diaphragm
- < 2% of all CHD
- Asymptomatic (incidental diagnosis)
- Surgical correction advised
- Risk of incarceration or strangulation of abdominal organs
- Outcomes excellent
- Abominal approach with primary or mesh closure
MCC of acquired diaphragmatic hernias
Trauma
- Diphragm rupture occurs in ~ 3-5% of patients admitted for trauma
- Associated with severe injuries, thus has high mortality
- Mostly due to blunt trauma
TOC for traumatic acquired diphragmatic hernia
Early surgical repair
(avoid compications of strangulation and obsruction)
- Prognosis highly influenced by severity of associated abdominal and overall injury scores
Etilogy of diaphragmatic eventration
Failure of myoblast migration to muscular portion of diaphragm, impairing ability to contract
Associated congenital defects with diaphragmatic eventration
- Spine and skelatal defects
- Hypoplastic lungs
- Pulmonary sequestration
- Transposition of viscera