Pediatric Diaphragmatic Hernias

Question 1

Definition of Diaphragmatic Hernia

Answer 1

Intra-abdominal contents (intestine, stomach, maybe liver/spleen) in thorax.

Question 2

List the 3 types of Diaphragmatic Hernia

Answer 2

■ Bochdalek: most common (90%). Occurs on left posterolateral chest wall (“back to da left, boch da lek”).

■ Morgagni: (2-6%). Anterior, retrosternal herniation.

■ Hiatal hernia: stomach/some intestines through esophageal hiatus.
Covered in surgery topic.

Question 3

Diagnosis of Diaphragmatic Hernia

Answer 3

Respiratory distress within the first few days of birth.

May have scaphoid (sucked-in) abdomen due to lung hypoplasia.

Large chest.

CXR/US confirms.

Question 4

Treatment of Diaphragmatic Hernia

Answer 4

■ If symptomatic at birth, immediately intubate (because a bag-valve
mask will hyperinflate the intestines and worsen the problem)

■ Severe cases may need ECMO to stabilize

■ Surgical repair when stable and pulmonary hypertension has resolves,
generally at least 48 hours old

Question 5

In which conditions is Diaphragmatic hernia associated with?

Answer 5

CNS abnormalities-CV abnormalities.

Esophageal atresia- Omphalocele.

Down-Turner-Patau syndromes.