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Diaphragmatic hernia. About diaphragmatic hernia of the fetus

Every mother dreams of a healthy and strong baby. However, no one is immune from diseases and congenital defects. Therefore, it is important to know about pathologies in order to detect and neutralize them in time. Diaphragmatic congenital hernia occurs in 1 newborn out of 2-4 thousand.

What is a diaphragmatic hernia?

This is a disease in which the organs abdominal cavity move into the chest through an opening in the diaphragm. According to research, diaphragmatic hernia usually occurs on the left side and most often in boys. Organs such as the stomach, loops of the small intestine, spleen and even the liver can move. They fill the chest cavity and prevent the lungs and heart from developing normally. In half of the cases, the baby also has concomitant defects: kidney, heart, gastrointestinal tract, central nervous system. In addition, diaphragmatic hernia may be accompanied by such hereditary diseases, like Down syndrome, Edwards syndrome and Patau syndrome.

You can find out more information about this disease by watching this video:

There are several types of this defect:

True hernia - abdominal organs penetrating through the diaphragm are covered thin shell(hernial sac)
False hernia - the organs penetrating through the gap are not covered with anything, as a result of which they put more pressure on the lungs and heart
Relaxation of the diaphragm is its complete absence. Internal organs move freely in the body cavity.

What can affect the development of a diaphragmatic hernia?

As a rule, fetal defects begin to develop at 4-5 weeks, but the exact causes and mechanisms of development of the hernia have not yet been established. However, several risk factors can be identified:

Substance use
Alcohol consumption
Smoking
Ionizing radiation
Taking certain medications (cytostatics and antibiotics)
Unfavorable environment.

This fetal defect can be detected using ultrasound, starting from the 12th week of pregnancy. A diaphragmatic hernia in a fetus is treated either in utero or after the baby is born.

Intrauterine and postpartum treatment

Modern medicine makes it possible to begin treatment for a hernia while the child is still in the womb. Surgery carried out at 26-28 weeks of pregnancy. Through a small hole in the tissue, a special balloon is inserted into the fetal trachea, which helps the lungs develop, and then it is removed (after childbirth or during pregnancy, depending on the effectiveness of the treatment). This method is prescribed when there is a high probability that the baby will not survive without surgery. However, surgical intervention is dangerous - they can start premature birth or a diaphragm rupture occurs.

Mostly, hernia is treated after childbirth. To help the newborn breathe, he is connected to a ventilator. Then surgery will be required. Surgeons will return the stray organs to the abdominal cavity and sew up the hole in the diaphragm. On average, the operation takes about 2 hours. In some cases, a synthetic flap is required to restore the diaphragm. In this case, when the child gets older, he will need another operation to replace the flap. After the operation, the baby will be put on a ventilator again, as he will still be very weak. In the future he will need to follow a special diet.

Congenital diaphragmatic hernia (CDH)

CDH occurs in 1 in 2000 births, including stillbirths. True nature EDH has become much better understood since fetal ultrasound examination has been widely introduced into practice. Of all cases of VLH detected in utero, 70-75% are associated with polyhydramnios. This rate of polyhydramnios may be somewhat overestimated, since one of the main reasons for ultrasound examination It is precisely the large size of the uterus that does not correspond to the gestational age, i.e. women with polyhydramnios are more often examined.

Nevertheless, there is no doubt that in the presence of polyhydramnios, mortality among children with CDH is especially high and amounts to 72-89%. In the absence of polyhydramnios, this figure is lower, but to date still exceeds 50%. Many of the children with CDH and polyhydramnios die immediately after birth from pulmonary failure, despite optimal resuscitation measures.

The cause of polyhydramnios appears to be a kinking of the gastroesophageal junction and/or pylorus, where the stomach protrudes into the chest, preventing the passage of swallowed amniotic fluid. When prolapsed in pleural cavity stomach mortality is usually higher than in cases where the stomach is located in its place in the abdominal cavity. The stomach is the contents of a hernia, usually in patients with a medially located large defect of the diaphragm. It is clear that the greater the number of organs moved into the chest, the more underdeveloped the lung.

In CDH, combined anomalies of other organs and systems are often encountered, since adverse effects on the embryo occur in early period formation of internal organs (at the 8th week of gestation). Of all children with CDH, 32% are stillborn. About 36% die before reaching the Neonatal Surgery Center. Almost all stillborns and those who die soon after birth have severe abnormalities of the nervous system, such as anencephaly, myelomeningocele, hydrocephalus, encephalocele and severe heart defects, as well as trisomy 13 and 18.

About 65% of children who die early are premature, born before 36 weeks of gestation with a body weight of less than 2500 g. This combination of severe anomalies and prematurity causes high mortality. Most newborns who survive to surgical intervention, as a rule, are full-term and do not have other anomalies.

Although the causes of CDH are unknown, it cannot be ruled out that a genetic factor plays a role, since there are reports of CDH in identical twins, siblings and cousins. Girls are affected almost twice as often as boys.

The diaphragm defect may be a small gap or a complete absence of all components of the thoraco-abdominal obstruction, including the crura (see Fig. 19-1). EDH in 80% of cases, according to the most different authors, occurs on the left, in 1% - on both sides. An intact pleuroperitoneal hernial sac is present in 20-40% of patients. When it limits bowel prolapse, children tend to survive.

Table 19-1. Pulmonary mediators blood pressure in newborns

Pathophysiology. When a child is born, difficulties arise in the passage of air into the lungs, since the most important mechanism of inhalation - contraction of the diaphragm - is missing, and, in addition, the mediastinum is shifted to the opposite side and both lungs are accordingly compressed. The negative pressure that develops during inhalation causes the intestines to protrude even further into the chest.

That matters too. that during respiratory distress, the child swallows a large amount of air, which distends the intestines, and this leads to further compression of the lung. The hernia itself, even with normally developed lungs, can lead to respiratory failure. And any degree of pulmonary hypoplasia causes severe disturbances in oxygenation and carbon dioxide removal.

In hypoplastic lungs, gas exchange is reduced due to a decrease in the surface of both the alveoli and the capillary bed. These lungs are not very flexible and expand slowly. Number of branches pulmonary artery is reduced, so the right ventricle is forced to forcefully push blood through a small vascular bed, which leads to dilation of the pulmonary artery and increased pressure in the right heart.

The pulmonary arteries are unusually thick muscle fibers, extending distal to the terminal bronchioles. This muscle layer is particularly susceptible to mediators of vasoconstriction (Table 19-1). As a result, gas exchange and pulmonary blood flow disturbances develop, pulmonary hypertension and right ventricle insufficiency. Blood shunting from right to left also occurs through ductus arteriosus And oval window, which aggravates systemic hypoxia, hypercannia and acidosis and leads to an increase in narrowing pulmonary vessels. If the clinical narrowing of the pulmonary vessels has already occurred, it is extremely difficult to correct it. Therefore, once a diagnosis of CDH is made, very aggressive treatment must be initiated immediately.

Diagnostics. The diagnosis can be made prenatally by ultrasound examination of pregnant women. The presence of polyhydramnios or a distended stomach located in the chest indicates a poor prognosis. If CDH is diagnosed, then it is necessary to examine the fetus for other defects, carefully examining the head, spine, heart and kidneys. To identify chromosomal and metabolic abnormalities, amniocentesis or chorionic villus biopsy is performed. If CDH is the only isolated anomaly, then the possibility and criteria for correcting the defect in utero in the fetus should be considered.

After birth, the diagnosis is made by the presence of difficulty breathing, cyanosis, scaphoid abdomen, displacement of heart sounds, and lack of breathing on the side of the hernia. Displacement of the trachea to the side or midline And bowel sounds in the chest are usually not detected. The severity of these symptoms varies widely: about 65% of all children with CDH die soon after birth, while 5% or more sometimes live asymptomatically for months or years before diagnosis is made.

Before radiography chest(the main diagnostic method), it is advisable to insert a probe into the stomach. If the radiograph is taken before air has filled the intestines, the chest on the affected side is obscured, but the trachea and heart are displaced to the opposite side and the contralateral lung is reduced in size. Most often, the intestines are filled with air, and sometimes these air shadows are mistaken for various forms of pulmonary cysts (Fig. 19-4).

Rice. 19-4. Chest X-ray showing gas-filled intestines in the left side of the chest. The trachea, air-contoured esophagus and heart are displaced to the right so much that only a small part of the right lung remains airy

VDG with late start manifestations. According to various authors, from 5 to 25% diaphragmatic hernia are detected after the neonatal period - at the age of 1 month to late old age. The diagnosis is sometimes made by chance, during a chest x-ray in patients with an asymptomatic hernia. If symptoms appear, they can be very mild or, conversely, extremely severe - both from the respiratory tract in the form of respiratory distress, and from the gastrointestinal tract - in the form of obstruction. Respiratory symptoms sometimes resemble those of a pulmonary infection, with fever and cough. Compression of the lungs can cause shortening of breathing.

Physical and X-ray examinations help differentiate pleural effusion, empyema or lung cysts. Abdominal pain, nausea, and vomiting are associated with compression of the intestine in the opening of the diaphragm, which leads to obstruction, or with impaired circulation of the intestine (with or without volvulus). If on a chest x-ray the diaphragm is not clearly contoured, “pulmonary cysts” are identified, and when examining the passage of a contrast agent through the gastrointestinal tract, penetration is visible small intestine through the diaphragm, the operation must be performed from a transabdominal approach.

K.U. Ashcraft, T.M. Holder

Congenital diaphragmatic hernias in newborns form in the fourth week of fetal development. It is during this period that a membrane is formed that separates the child’s chest cavity from the abdominal cavity.

Improper formation of individual muscles and ligaments of the diaphragm causes the formation of a hernial protrusion in children.

The disease can be diagnosed as early as 22–24 weeks of pregnancy. Identify pathology experienced specialist may during an ultrasound examination.

After the birth of the baby, the disease is detected against the background of its clinical manifestations and using methods instrumental diagnostics. Most often, this is done by x-ray examination and examination of the digestive organs using a special x-ray contrast agent.

Often, a diaphragmatic hernia is incompatible with the life of the child; in 50% of cases, the pathology provokes the death of the newborn.

The clinical picture of the disease in a child depends on the type and size of the hernia. With the development of large hernias in children, conditions are diagnosed that indicate compression of the lungs and impaired blood flow due to pathological displacement of the heart.

In the first stages of a baby's life heartbeat remains normal, but significant disruption may occur at any time of cardio-vascular system.

The consequence of such disorders is asphyxia and increased heart rate.

A characteristic symptom The presence of pathology is the baby's quiet crying immediately after birth, this indicates difficulty breathing due to the inability to fully open the lungs.

In order to clarify the diagnosis after the birth of the baby, it is first necessary to conduct an x-ray examination.

Fluoroscopy and radiography reveal irregularly shaped clear spots, resembling a honeycomb, localized on the corresponding side of the chest. In some cases, so-called “round shadows” are considered.

The heart is generally displaced to the right.

The diaphragmatic dome is almost indistinguishable.

To provide normal breathing In the first hours after the baby is born, ventilation is carried out.

For diaphragmatic hernia in newborns, the only treatment option is surgery. In case of asphyxial strangulation or signs of diaphragm rupture, it is performed urgently.

During the first stage of surgical intervention in a child, in case of a small volume of the abdominal cavity, which does not accommodate the organs removed from the pleural part, an artificial ventral hernia.

The second stage is carried out after a period of 6 days to a year from the date of the first operation. During the second intervention, the artificial hernia is repaired. Drainage of the pleural cavity is also carried out.

It should be noted with regret that the likelihood of complications developing after such operations is quite high and is approximately 50%. The most common occurrences are:

complications general type: febrile conditions, water-salt imbalance, depression of the respiratory center;
pulmonary complications: pneumonia, edema, pleurisy;
complications from organs located in the abdominal cavity - mainly different kinds intestinal obstruction;
significant increase intra-abdominal pressure against the background of limited motor function of the diaphragm and compression of the inferior vena cava.

With paraesophageal hernias, which are typically located near the esophagus, relapses of the disease occur most often after surgery.

To prevent them after the end of the breastfeeding period, it is necessary, in addition to strictly following the doctor’s prescriptions, to follow therapeutic diet, designed specifically for such cases.

During the postoperative period, the baby should be on prolonged mechanical ventilation.

Adverse consequences after the procedure surgical treatment can be observed in 10-30% of cases.

Children with similar congenital hernia diaphragms must be subject to surgical treatment. Since children often die even before surgery from concomitant complications of the disease, it is important to adequately organize care for the child before surgical intervention.

Pathogenesis

The formation of the defect begins in the fourth week of embryonic development, at the stage of formation of the membrane between the abdominal cavity and the pericardial cavity of the fetus. Suspension of the development of individual muscle structures in some areas of the diaphragm provokes the appearance of a hernia with a hernial sac.

The walls of the sac are formed by the serous membranes of the pleural and abdominal layers. In this way, true hernias are formed.

The formation of false hernias is caused by the movement (through a through diaphragmatic hole) of the abdominal organs not covered by the hernial sac into the chest without restrictions, resulting in the development of intrathoracic tension syndrome.

Causes

It is still not possible to accurately determine the causes of the development of pathology. IN medical practice There are several most likely factors that provoke the disease:

A woman has a difficult pregnancy.
Diseases in pregnant women associated with constipation and other digestive disorders.
Difficult childbirth.
Diseases of the respiratory system.
Lifting weights while carrying a child.
Taking certain medications and drugs.
Bad habits.
A woman's experience of stress and excessive anxiety.

Due to negative influences on female body are developing pathological processes, provoking abnormal development of the diaphragm in an infant (a true type of pathology).

Diagnosis of pathology is carried out during the period of intrauterine development. The presence of the disease is indicated by such signs in the fetus as displacement of the heart to one side (mainly right-sided placement), various deviations in the structure of the internal organs.

Perinatal diagnosis is carried out using ultrasound.

After the baby is born, doctors diagnose the disease by external signs:

abnormal protrusion of the chest of a newborn:
difficulty breathing, weak crying;
improper redistribution of breathing throughout the chest;
presence of intestinal rumbling in the chest.

More accurate results (necessary for differential diagnosis) and confirmation of the diagnosis is obtained after carrying out the methods instrumental research. These include ultrasound, computed tomography, analysis of blood gas levels.

severe pregnancy;

frequent constipation;

complicated childbirth;

the woman has some chronic diseases of the respiratory system;

taking certain medications;

bad habits(smoking, drinking alcohol).

Such diagnostics are carried out using ultrasound or magnetic resonance imaging.

A woman is diagnosed with polyhydramnios, the cause of which is a bend in the fetal esophagus due to displacement of its internal organs and disruption of the process of swallowing amniotic fluid.

The diagnosis is made after parts of the abdominal organs are found in the chest.

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There are several ways in which a specialist can diagnose the presence of a diaphragmatic hernia in a child while he is still in the womb.

For example, when perinatal diagnosis, which is carried out using ultrasound, polyhydramnios is detected in the expectant mother.

The reason for this phenomenon is a bend in the baby’s esophagus, which occurs due to the displacement of its organs. The final diagnosis is made only after identifying parts of the internal organs of the peritoneum in the fetal chest.

In some cases, dropsy is detected in the fetus. When dropsy is detected, the further development of the child in the womb is monitored using ultrasound.

If a diaphragmatic hernia is detected in the fetus, a consultation of specialists is held, at which the prognosis of the disease, methods of childbirth and subsequent treatment of the pathology are discussed. In some cases, emergency termination of pregnancy may be required.

After the birth of the child, in order to clarify the previously made diagnosis, radiography is performed. During x-ray examination The specialist discovers clearings in the newborn that visually resemble honeycombs. In this case, the baby’s heart, as a rule, is slightly shifted to the right.

During the examination, the specialist excludes or confirms the presence of such pathologies in the baby as pulmonary cyst, congenital heart disease, dextrocardia, esophageal atresia, liver tumor, birth defects breathing and intracranial hemorrhages.

This defect forms at the very beginning of embryo development, from about the 4th week. At this stage, a membrane is formed between the peritoneum and the pericardium.

If suddenly the development of muscle structures is suspended or impaired, a hernia may develop with a hernial sac formed from the serous membranes of the abdominal and pleural layers.

Thanks to new technologies in medicine, it is possible to recognize an abnormality of intrauterine development through ultrasound examination. Modern methods diagnostics help to establish the presence and degree of development of a hernia and diagnose accurate diagnosis already at the end of the first trimester of pregnancy.

The first alarm bells: polyhydramnios, an enlarged, elongated stomach located in the chest - may be a reason for a more thorough examination.

There is no precisely established cause of congenital hiatal hernia, but many risk factors are known that directly or indirectly influence the development of this pathology.

A child can be diagnosed with a true or false hernia. In the first case, the hernial sac is formed by the pleural and abdominal layers.

False anomalies are manifested by the release of organs not covered by the sac into the chest cavity, which provokes intrathoracic tension syndrome.

A common form of pathology in a child is congenital Bogdalek diaphragmatic hernia, when organs move through the posterior parietal defect of the diaphragm.

Prenatal diagnosis is possible through ultrasound and magnetic resonance imaging. Both methods are safe during pregnancy and can be used repeatedly. An indirect sign of pathology is polyhydramnios due to impaired ingestion of amniotic fluid by the fetus.

Experts identify the following factors that can lead to the appearance of a hernia:

congenital deformities;
mechanical injuries, especially often of the diaphragmatic variety;
aging of a mustachioed pet;
various problems with animal defecation - diarrhea or constipation;
undergone surgery castration or sterilization of a cat;
childbirth.

The symptoms of the pathology depend entirely on the location of the hernia and those organs that were pinched. In view of this, we will consider each variety in more detail.

Diaphragmatic hernia

The animal becomes apathetic and inactive. Over time, breathing problems appear - shortness of breath or attacks of suffocation.

Regular oxygen deprivation of the body causes the mucous membranes of the cat to turn blue. In particularly difficult cases, pulmonary edema is very likely, provoked by the pressure of the abdominal organs on the large vessels of the pet’s body.

Umbilical hernia

In the abdominal area, protrusion of tissue is clearly visible. It is soft to the touch and does not cause painful reactions in the cat upon palpation.

If pinching does not occur, then the pathology when pressed is well “put into place” when you press on it. Otherwise, signs such as increased body temperature, pain during palpation, and severe vomiting are possible.

In case of failure to provide timely medical care, a umbilical hernia can cause sepsis and death of adjacent tissue. This type of disease is typical of kittens, especially those 3 weeks old, whose umbilical cord was cut too close to the belly.

Inguinal type

The diagnosis of external protrusion is based on the clinical symptoms of the disease, as well as with the help of palpation, thanks to which the specialist is able to determine the presence or absence of pinching.

If a cat is suspected of having an internal form of pathology (intervertebral or diaphragmatic varieties), then additional diagnostic procedures, including ultrasound, x-ray, myelography and MRI.

With external protrusions, diagnosis is usually based on clinical signs of the disease. Veterinarian it is carefully palpated to determine pinching.

For internal hernias (intervertebral and diaphragmatic), a mandatory appointment additional methods diagnostics

x-ray,
myelography.

Factors that lead to the development of diaphragmatic hernias can be divided into predisposing and producing.

Predisposing factors include: congenital or acquired weakness connective tissue, traumatic injuries diaphragm, dystrophic changes muscular-ligamentous apparatus, etc.

Producing (implementing) factors are all conditions associated with increased intra-abdominal pressure: heavy physical labor, heavy lifting, pregnancy, constipation, generous reception food and regular overeating.

A general practitioner may suspect the presence of a diaphragmatic hernia in a patient based on questioning and examination. To clarify the diagnosis, an X-ray contrast study is performed (before the study, the patient is asked to drink something that is harmless to the body contrast agent barium suspension) and esophagogastroduodenoscopy (EGD).

Diagnosis of diaphragmatic hernia is based on medical history (the owner describes an episode of injury), physical examination and chest x-ray. Typically the disappearance of the diaphragm line, shading of the cardio silhouette, displacement of the pulmonary lobes.

Symptoms

If the fetus has a diaphragmatic hernia, the likelihood of premature birth is quite high. Given its small size, it is possible asymptomatic diseases.

The development of characteristic complications with typical manifestations of cerebral intraventricular hemorrhage, surfactant deficiency and sepsis is possible.

If the diaphragmatic hernia is of significant size, the manifestation of symptoms is primarily associated with the process of compression of the lungs and disruption of normal blood circulation as a result of displacement of the mediastinum and heart.

1. Children with this pathology may be born seemingly healthy, but do not cry very much, since the lungs are not able to expand completely, and breathing is significantly difficult.

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2. Another important sign of the disease is cyanosis. With him early manifestation and rapid growth, the baby may die on the first day after birth.

The prognosis worsens in direct proportion to the time of development of cyanosis: the earlier it manifests itself, the less chance there is to save the child.

If a child is diagnosed with a diaphragmatic hernia, the risk of premature birth increases greatly. If the hernia is small in size, the disease usually occurs without symptoms.

At large size Hernia main symptoms are most often associated with compression of internal organs.

At first glance, children with a diaphragmatic hernia are born healthy, but they cry much more intensely because the lungs cannot expand properly and breathing is difficult.

One of the main signs of the development of this pathology is cyanosis. If it increases rapidly, the newborn may die 24 hours after birth.

In certain cases, cyanosis may appear in a baby after an attack of suffocation during feeding. Suddenly the baby begins to turn blue and suffocate.

Such symptoms sometimes go away when the baby is placed in an upright position or on its side. In some cases, the newborn may vomit and the pulse may accelerate due to systematic attacks of suffocation.

An important sign Diaphragmatic hernia is a fairly rare anomaly called dextrocardia. With it, part of the heart is located not on the left, as it should be, but on the right.

Externally, you can notice a certain asymmetry of the sternum in a newborn. The side on which the hernia is located is slightly convex, and the other is slightly sunken.

If a newborn with a diaphragmatic hernia is not helped in time, the cyanosis will intensify, and soon the baby’s skin will acquire a bluish tint.

The breathing process will gradually begin to deteriorate due to insufficient oxygen supply. At the same time, the weight of the newborn does not increase within a few days after birth, and sometimes begins to decrease.

If a baby has a diaphragmatic hernia, the following manifestations are also noted:

child's refusal to feed;
pulmonary inflammation;
hemorrhage.

The pathology, considered one of the most dangerous and complex in veterinary medicine, can be congenital, but most often it is acquired, formed as a result of mechanical trauma.

Under the pressure of a hernia, the abdominal organs exert extreme pressure on the lungs, heart and diaphragm area until it ruptures.

A diaphragmatic hernia in a cat is practically impossible to diagnose; even an ultrasound shows cloudy areas of darkening. An accurate diagnosis can be made using a chest x-ray, but before this the animal must be given barium pulp.

Clinical symptoms in kittens they are not pronounced. The cat refuses to eat, becomes inactive, lethargic, breathing is intermittent, rapid, with attacks of shortness of breath, the pulse is thready. In some cases, due to severe compression of the chest vessels, pulmonary edema develops.

Treatment is surgical.

Each type of hernia has its own specific manifestations, by which it can be easily identified.

The average incidence of this disease is one case in 2,200 infants. According to statistics, approximately 30% of children with this pathology are already born dead, 35% do not have time to save - they die before they are admitted to the surgery department.

With early detection and immediate surgical intervention, many are able to live a full life, otherwise the child may die.

On the other hand, some patients with CDH (if it is small) can live for years without bright severe symptoms diseases, feeling only heartburn, belching after eating, bloating.

Sometimes the process of swallowing food is difficult. But over time, the disease will make itself felt with nausea, loss of appetite and pain in the sternum.

The severity of the disease depends on the size of the hernia and the degree of pathology. How to recognize it? The larger it is, the greater the pressure on the lungs, heart, the baby cannot breathe fully, blood circulation, digestion are impaired (due to displacement of organs), and so on.

Treatment is divided into two types: conservative and surgical. The first option is ideal for cases where the hernia protrudes slightly and there is no pinching at all.

Most often, elimination occurs without surgical intervention. inguinal forms illness. For this method of treatment, the cat is put on a tightening blanket, which he will be required to wear for a couple of months in a row, and the bulge itself is first adjusted by a doctor.

In this case, the abdominal defect can heal on its own.

If the veterinarian, after diagnosis, determines that conservative treatment does not give a positive result, then removal of the hernia will be required. Moreover, without pinching, the operation is carried out according to the following scheme: the protruding organ is reduced and the wound is sutured.

And with pinching this way: the hernia sac is excised absolutely completely, along with those internal organs that were pinched in it.

Diaphragmatic and intervertebral hernias deserve special attention. In the first case, the animal’s chest is opened by a surgeon, and the organs “retracted” into it are set back into the abdominal cavity.

Then the diaphragm is sutured, but before that the doctor performs plastic surgery by placing a special mesh on this part of the cat’s body or using adjacent tissue.

If organs are infringed, then be prepared for the fact that their resection will be required. It is important for owners to understand that the cat will need careful post-operative monitoring.

This will help prevent the lungs from collapsing or blood circulation in the sternum being disrupted.

In case of intervertebral hernias on early stages drug therapy is possible. Both steroidal (Prednisolone) and non-steroidal (Rimadyl) drugs have proven effective.

Please note that you will need to observe restrictions on the movement of your mustachioed pet for 1-2 months. If the disease was discovered late, then the prolapsed disc and part of the vertebra at the site of the pathology are removed surgically.

After the operation, the pet will be exhausted, so he will be prescribed courses of vitamins and complete rest. Unfortunately, this hernia is late stages incurable.

In order not to torment the cat, the doctor will recommend euthanasia.

Due to the rich localization of hernias in cats, symptoms differ depending on their location and the pinched organs.

Diaphragmatic - the cat becomes lethargic and apathetic. Breathing problems begin - often with attacks of shortness of breath or suffocation, which becomes rapid and superficial. With a prolonged course of such respiratory disorders, cyanosis of the mucous membranes develops due to oxygen starvation. Possible complication of the condition due to compression abdominal organs large vessels - pulmonary edema.
Umbilical - is a soft and painless protrusion in the abdominal area; if the hernia is not pinched, then when you press on it, it easily “hides” inside. If pinched, the cat may experience vomiting, a sharp increase in temperature and pain at the site of the protrusion. Subsequently, the organs in the hernial sac in the absence of adequate therapy may become necrotic and cause suppuration and sepsis.
Inguinal – looks like a soft ball of dough-like consistency in the lower abdomen. Most often observed in females. In animals this disease is not a cause for concern, however this pathology may lead to uterine prolapse or Bladder. This may lead to infertility or development state of shock when the bubble bursts.
Perineal - as with the previous type, the hernia is absolutely painless. She easily changes her position. especially when lifting a cat by its paws. If behind the front ones, the protrusion increases, the rear ones are retracted back.
Intervertebral hernias in cats are usually localized in the lumbar vertebrae. The pet may experience poor coordination of movements, problems with walking and jumping, up to the development of atrophy of the muscles of the limbs and paralysis. In case of serious degenerative changes in the pinched spinal cord possible development central paralysis and serious neurological disorders. In this case, treatment is no longer possible due to the development of deep tissue damage to the spinal cord.

Many children suffer from hernias, which is very dangerous if the child is an infant. Diaphragmatic hernia in newborns is rarely diagnosed, but it can threaten the life of a little person if measures are not taken in time.

With this disease, organs move from the abdominal cavity to the thoracic cavity. This affects the activity of the entire organism. Due to a hernia, the newborn has little weight and developmental delay. Organs from the peritoneum move to the chest area through a pathological or natural hole in the diaphragm. The wider the hernial opening, the more organs get into it, which leads to worsening blood circulation and breathing.

Development of the disease

Pathology begins to develop in the fourth week of pregnancy. When the muscles in certain places of the diaphragm stop developing, a hernia forms.

Experts determine the severity of the condition using several factors. First of all, they pay attention to the volume of organs that have moved into the chest. The movement is accompanied by malformations of the heart, lungs, nervous system, kidneys and gastrointestinal tract.

If a newborn pulmonary failure, then even surgery cannot improve his condition.

Diaphragmatic hernia in children has several types:

diaphragmatic-pleural, which can be true or false;
parasternal periosternal - classified as true;
hiatal hernias are also classified as true.

Most often, diaphragmatic-pleural hernias and esophageal openings appear.

Symptoms

Birth is most likely to be premature if the newborn has a disease. If it is small in size, then there are no symptoms.

Diaphragmatic hernia in children is sometimes on the left side, so it affects the position of the heart. If you take an x-ray, you can see that most of it is on the right side. This effect is called dextrocardia.

Due to asphyxia, the activity of the heart muscle may deteriorate. The pulse accelerates.
Another sign is a sunken stomach. During breathing, retraction of the epigastric part is observed.
Newborns with this malformation have underdeveloped lungs, as they are compressed by the abdominal organs. Breathing is accompanied by intestinal peristaltic sounds.
The child's weight decreases as he refuses to eat and blood circulation is impaired.
If a hernia strongly compresses the mediastinum, venous flow to the heart is disrupted. This leads to arterial hypotension.
An electrocardiogram may show myocardial hypoxia.

The occurrence of anemia, pneumonia, and intestinal hemorrhage cannot be ruled out.

Causes

Experts identify various prerequisites for the occurrence of the disease, although this disease has not been fully studied. No doctor can name the exact cause of the disease. Among the main reasons are:

As a result, the process of laying the fetal organs is disrupted. This provokes improper development of the diaphragm.

Diaphragmatic hernias can occur not only on the right or left side, sometimes they appear on both sides. This arrangement leads to the death of the newborn.

Diagnostics

Congenital diaphragmatic hernia in babies is detected before birth thanks to ultrasound. Diagnosis is carried out from 22 to 24 weeks of pregnancy. U expectant mother observed polyhydramnios. It occurs due to a bend in the fetal esophagus. The bend occurs due to the displacement of organs, as a result of which the process of swallowing amniotic fluid is disrupted.

During pregnancy, ultrasound examinations are required. With their help, doctors monitor the growth of the fetus and the presence of deviations from the norm. If you identify the problem in time, there will be more opportunities to prevent unwanted consequences and deaths.

One of the symptoms is the absence of a gastric gas bubble in the abdominal cavity. The occurrence of dropsy is possible, as venous edema develops. This disease should be monitored by ultrasound examinations. During diagnosis, an amniotic sac is punctured to obtain a sample. amniotic fluid and analyze them.

If a diagnosis is made, a consultation is held, which includes a perinatologist, pediatric surgeon, resuscitator and obstetrician. They must determine the prognosis for the further development of the disease, find a way for delivery and think about treatment options.

Treatment

To treat the baby, fetoscopic correction is performed in utero. If the child’s life is at risk, a balloon is inserted into his trachea, which promotes lung development. This procedure has its side effects. Artificial lung stimulation can lead to rupture of the diaphragm, or it will form very weak. As for the mother, she faces difficult premature birth.

Diaphragmatic hernia in newborns can only be eliminated surgically. If the operation is performed on time, the chances of life will be high. The disease is not always identified before birth. To clarify the diagnosis, the newborn is given an x-ray. This examination makes it possible to detect clearings that have irregular shape. It is practically impossible to distinguish the diaphragmatic dome.

Specialists should exclude:

The newborn should be immediately artificial ventilation lungs and perform surgery. It is carried out in two stages. Specialists will have to secure the hole in the diaphragm. A special synthetic material is sewn into the fabric of the hole. It will be removed after some time.

Adverse consequences often develop after surgery. Among them:

pneumonia, edema, pleurisy;
fever, breathing problems;
intestinal obstruction;
increased intra-abdominal pressure.

To eliminate and prevent complications, you should follow the recommendations of specialists and follow the diet that is always prescribed in such cases. After the operation, the newborn is transferred to prolonged artificial ventilation.

Diaphragmatic hernia in newborns is a pathological condition in which abdominal organs prolapse into the chest through a hole in the diaphragm, which should not normally occur. It is a rare developmental defect found in 5 newborns out of 1000. The process of formation of a hernial orifice begins 3-4 weeks after conception, when a septum is formed between the thoracic and abdominal cavities. Underdevelopment of the muscle tissue of the diaphragm contributes to the appearance of the defect.

Causes

The exact causes of diaphragmatic hernias are not clear. Provoking factors include:

smoking, drinking alcohol and drugs during pregnancy;
complicated pregnancy;
exacerbation of severe chronic pathologies of the liver, kidneys, heart and lungs during pregnancy;
severe course of the labor period;
engaging in heavy physical labor in the early stages of pregnancy;
taking medications that have Negative influence on fetal development;
undergoing an X-ray examination in the first weeks of intrauterine development of the fetus;
penetration of toxic substances into the body of a pregnant woman;
consequences of chest and abdominal injuries in newborns;
chronic diseases of the respiratory system, causing prolonged coughing attacks.

Symptoms

Small hernias do not have typical symptoms, which makes diagnosis difficult. The appearance of secondary pathologies associated with impaired blood circulation in the internal organs, deficiency of surfactant (a substance that triggers the breathing process after cutting the umbilical cord) and blood poisoning is possible. At large sizes Hernial protrusion causes symptoms associated with displacement of internal organs and impaired gas exchange in the body. The clinical picture of a diaphragmatic hernia includes:

Diagnostics

Prenatal diagnosis is carried out in the first days of life. Ultrasound and magnetic resonance imaging are used for this. Procedures help detect indirect signs pathologies:

Deviation of amniotic fluid volume from the norm. Due to compression of the esophagus and upper stomach, the fetus cannot swallow amniotic fluid.
Displacement of parts of the stomach, small intestine or gallbladder towards the chest.
Peristaltic loops of intestine containing fluid. Found on the left side of the chest.
Absence of the stomach in its place anatomical location. Refers to additional diagnostic symptoms hernias hiatus diaphragm.
Movement of the gallbladder into the pleural cavity. Accompanied by displacement of the liver in top part belly.
Changes in the position of the heart and mediastinum. Occurs due to pressure caused by a large hernia.
Signs of accumulation excess liquid V cranium and testicles. Development of these pathological conditions promotes venous stagnation.

Classification

Congenital

Among the hernias of this group are:

True protrusions. They develop against the background of weakening and sagging of the muscles of the dome of the diaphragm, caused by a sharp increase in abdominal pressure. Organs fall out through holes located in the sternum and lower back. In the cavity of the hernial sac there are loops of intestine, big oil seal and abdominal tissue.
False. The formation of such a protrusion is facilitated by aplasia (absence) of some parts of the diaphragm. In this case, communications arise between the thoracic and abdominal regions.
Atypical. Such hernias are rarely diagnosed. They are distinguished from other malformations of internal organs by the presence of a characteristic hernial opening.

Traumatic

Such protrusions are formed against the background of the consequences of closed or open injuries sternum, accompanied by prolapse of internal organs through the resulting defect. A hernia forms at the time of injury or several months after it. Traumatic hernias most often have a left-sided nature, the hernial gap runs across the border between muscles and tendons.

In this case, the hernial sac is absent, so the protrusion is considered false. The tumor cavity contains parts of the stomach and intestines, liver and gall bladder.

Neuropathic

This form of the disease develops against the background of relaxation of the diaphragmatic muscles. The emergence pathological changes contributes to disruption of innervation caused by inflammation of nerve endings, damage to the brain and respiratory organs.

Esophageal hiatus diaphragm

A hiatal hernia is the most common type of congenital protrusion.

It is characterized by the movement of abdominal organs behind the sternum.

Has progressive chronic course. Occurs against the background of pathological expansion of the esophageal opening.

Treatment

A diaphragmatic hernia can only be cured through surgery. Several methods are used in surgery, the choice of which depends on the stage of fetal development.

Surgeries are performed both before and after birth. Transporting a newborn with a congenital hernia can be difficult, so if a defect is detected during intrauterine development, the birth takes place in a perinatal center. The operation begins immediately after the birth of the child.

Intrauterine

This intervention is carried out in the 2nd trimester of pregnancy. Tools are entered via small puncture in the wall of the uterus. IN Airways A device is inserted into the fetus to help open the lungs. After birth, the balloon is removed.

Fetoscopic intervention is prescribed in the presence of defects incompatible with life.

However, even correct execution surgery does not guarantee a 100% chance of survival. Intervention may provoke premature birth or lead to respiratory injury.

In a baby

When the diaphragm ruptures or organs are compressed preparatory stage excluded. The operation includes the following steps:

Artificial creation of anterior hernia abdominal wall by endoscopy. Indicated for a pronounced decrease in the volume of the abdominal cavity, which prevents the organs from returning to their normal position.
Elimination of artificial protrusion. The second stage of the operation is scheduled 7-365 days after the first. During the intervention, the hernial opening is closed and the pleural cavity is washed.

Forecast

Survival depends on the size of diaphragmatic hernias in children. The prognosis is influenced by the presence of concomitant defects and the time of the start of the operation. If intrauterine correction is refused, 40-75% of children survive. When attempting fetal correction, the probability of fetal death is 60%. 7% of newborns die in the first hours of life.

Complications

With a diaphragmatic hernia, the following complications may develop:

Duodeno-gastric reflux. Characterized by the constant entry of gastric and intestinal contents into the esophagus.
Inflammation of the mucous membranes of the esophagus. This consequence is characteristic of sliding hernias, accompanied by gastric juice V upper sections digestive system.
elimination of chronic diseases in pregnant women;
reducing the risk of intrauterine infection of the fetus through early vaccination.

During pregnancy, it is necessary to regularly visit an obstetrician-gynecologist and undergo an ultrasound examination.