home Analyzes I. Congenital diaphragmatic hernia. What is a diaphragmatic hernia in newborns?

I. Congenital diaphragmatic hernia. What is a diaphragmatic hernia in newborns?

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

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

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.

This is how a true hernia is formed, and a false hernia occurs when organs not covered by the sac penetrate the chest through the through diaphragmatic hole. This leads to intrathoracic tension syndrome. The most common of them is Bogdalek's hernia.

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

The following can cause disruption of the formation of the diaphragm and the development of a hernia:

Exposure to ethanol and drugs;
Smoking during pregnancy;
Negative effects of harmful substances from environment at work or due to living in environmentally unfavorable regions;
Taking medications with a teratogenic effect;
Exposure of the embryo to ionizing radiation.

Symptoms

Clinical manifestations pathologies depend on its type and the degree of compression of organs. Based on the location of the hole, all diaphragmatic hernias are divided into:

Diaphragmatic-pleural. They are located predominantly on the left and can be either true or false. Such hernias are very big size, and can skip the entire intestine, leading to acute respiratory failure.
Parasternal. There are only true ones and are located behind the sternum.
Hernias hiatus. Also there are only true ones.

A child with a diaphragmatic pleural hernia develops shortness of breath and cyanosis immediately after birth or after some time. Such babies cry quietly, since the lungs do not open completely. In most cases it is observed sharp deterioration baby's condition. On examination you may notice asymmetry chest. There is a protrusion on the affected side, with the tummy looking sunken.

If the hernia is small, the symptoms will be less pronounced - breathing problems will appear only while feeding the child and when changing body position. 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 pinching of the stomach wall at the opening of the hernia.

The symptoms of a parasternal hernia are not very pronounced, and they do not appear all the time. Sometimes children experience nausea and vomiting, and abdominal pain is noticeable. Breathing remains normal in most cases.

With hiatal hernias in babies, gastroesophageal reflux is observed. They spit up frequently and have difficulty swallowing, making it difficult for them to gain weight. In a few weeks, the baby may not only not gain an ounce of weight, but also lose weight. In addition, they experience:

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

Diagnostics

If the hernia is large enough, it can be detected by ultrasound later 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 a bend in the esophagus, the baby in the womb cannot swallow amniotic fluid, so there is too much of it.

If the hole is small, symptoms may be detected after birth or even much later. Put accurate diagnosis X-rays of the abdominal organs will help; usually displaced intestinal loops are clearly visible in the images.

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

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

Mediastinal tumors;
Bronchogenic cysts;
Adenomatous cystic transformation lungs.

If the presence of a hernia is suspected, perinatal period may require amniocentesis for collection amniotic fluid. The amount of special pulmonary surfactants in the amniotic fluid will determine the level of their production and the condition of the organ.

If a diaphragmatic hernia is diagnosed before the birth of the child, a consultation must be convened to determine how viable the fetus is and what treatment it will require. In particular difficult situations Doctors may recommend individual termination of pregnancy.

Treatment

The only way to treat a diaphragmatic hernia is surgical intervention. 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 fetal trachea, which stimulates the development of the embryo's lungs. Later it is removed, and the second operation can be performed both before and after childbirth.

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

If immediately after birth the baby is diagnosed with asphyxial strangulation or rupture of the diaphragm, the operation is performed urgently. In other cases, intervention can be delayed a little. Unfortunately, after surgery, complications develop in approximately 50% of cases.

Forecast

Prognosis for this pathology depends on the size of the defect and the presence of accompanying defects. The quality and timeliness of assistance provided are also important. Only doctors can give more or less accurate forecasts after a thorough examination.

Congenital diaphragmatic hernia in children is a rare anomaly of intrauterine development of the fetus, which is characterized by the movement of abdominal organs into the chest through the esophageal opening in the diaphragm. This pathology in adults is not considered dangerous, but for children this defect can cost their lives. For the first time, a diaphragmatic hernia in a fetus may be detected during prenatal diagnosis, but washed-out signs will not allow an accurate diagnosis.

After birth, the baby can observe specific manifestations of pathology in the form of cyanosis, foamy discharge from the mouth, weak crying and heavy breathing.

A congenital diaphragmatic hernia begins its formation from the 4th week of pregnancy, when the formation of a wall between the cavities of the peritoneum and pericardium occurs. At this time various reasons the development of individual muscle structures is disrupted, defects appear on the diaphragm, which become a factor in the appearance of a hernial sac with contents in the form of the stomach and part of the intestine.

Causes of congenital diaphragmatic hernia

Exactly established cause There is no 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.

In addition, a diaphragmatic hernia can occur in a child after birth, then the treatment approach will be different, and the acquired form of the pathology has a favorable prognosis.

TSo why does congenital diaphragmatic disease occur?(UNDER)herniain a newborn:

severe pregnancy with toxicosis;
exacerbation of systemic pathologies in a pregnant woman;
frequent constipation, bloating and other gastrointestinal disorders;
respiratory diseases;
reception medicines and narcotic drugs;
drinking alcohol, smoking;
severe stress, constant worries of the pregnant woman.

Acquired diaphragmatic hernia in newborns occurs after birth in the first few months of life.

The reasons are frequent constipation, hysterical crying and strong screaming. This disease is associated with anomalies of intrauterine development, mainly with weakness of the thoraco-abdominal diaphragm, but this factor alone cannot trigger pathological process. For the disease to appear, other conditions are needed that provoke an increase in intra-abdominal pressure.

How does the disease manifest itself?

The abdominal organs that have penetrated through the diaphragm begin to put pressure on the baby’s lungs and heart, and therefore their formation is disrupted. Congenital hiatal hernia is often combined with other anomalies of intrauterine development, and this further aggravates serious condition newborn More often, a child is diagnosed with a left-sided hernia, but the defect can appear anywhere.

Symptoms of the pathology will not depend on the location of the hernial orifice, but their severity is influenced by the contents of the sac, its size and associated disorders. A hiatal hernia will have severe consequences for the baby, regardless of the clinic, and an asymptomatic course will only worsen the condition.

Immediately after birth, the child may appear completely healthy in appearance.

In this case, an indirect sign of pathology will be weak crying, because the lungs do not open completely. At the same time, it may be difficult for the baby to breathe, and then cyanosis can be observed. Blueness of the skin appears already on the first day, and the sooner this happens, the less chance provide adequate assistance to the child, saving life.

Cyanosis often occurs after several attacks of asphyxia during feeding. The child begins to choke, the skin turns blue, the muscles are tense. These manifestations subside when the baby is placed on his side on the side of the hernia. With the first attack of asphyxia, the child undergoes an X-ray examination to confirm the disease.

TOilluminatedsymptomsdiaphragmatic herniaThe child has:

vomit - does not always appear and is not a specific manifestation;
cough - rarely occurs due to food particles getting stuck in the esophagus;
asymmetry of the chest cavity- this speaks of dextrocardia, movement of the heart;
superficial rapid breathing - tachypnea is accompanied by tachycardia, cyanosis, bloating, and disruption of important reflexes.

ABOUTgeneral symptoms of hiatal hernia from birth:

low weight and slow gain;
lack of appetite;
pale or bluish skin;
pneumonia;
blood in stool and vomit;
pathologies of the heart and respiratory system.

Types of hiatal hernia in newborns

Congenital diaphragmatic hernia can be true or false. The true one, in turn, is periosternal, phrenopericardial and esophageal. False can be traumatic, diaphragmatic-pleural. In rare cases, several forms of pathology are combined, and most often in children, diaphragmatic-pleural hernias are diagnosed.

To confirm the form of the disease, the child undergoes an ultrasound, a blood test is taken, and an additional CT scan, endoscopic examination, and esophagogastroscopy are prescribed.

Diagnosis before and after birth

Prenatal diagnosis is possible by ultrasound examination 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.

It is rare to see fluid-filled intestines in the chest, but the diagnosis is made when any abdominal organ is found above the diaphragm. A specific sign of the disease will be a violation of the position of the heart, which moves to the side. The fetus may also exhibit hydrops due to impaired venous outflow. Differential prenatal diagnosis is carried out with such pathologies as benign neoplasm, cyst and adenomatous transformation of the lungs.

After birth, the child is prescribed x-rays. In the image, the doctor sees areas of clearing in the shape of a honeycomb, which are located on the side of the defect. The heart turns out to be slightly shifted to the right, the dome of the diaphragm is practically not defined.

Differential diagnosis after the birth of a baby is carried out with atresia and stenosis of the esophagus, hemorrhage in the brain, liver tumors and impaired ventilation of the alveoli.

Treatment methods

If a severe form of pathology is detected during pregnancy, treatment begins immediately. The main method of prenatal therapy is correction of tracheal occlusion. The operation is scheduled between 26 and 28 weeks. The essence of the procedure will be the introduction of a balloon into the trachea of the fetus, which stimulates the development of the lungs. It is removed during childbirth or after the baby is born.

This operation is performed in severe cases of pathology and only in specialized centers. The prognosis of the disease depends on many factors, and the probability of cure is 50%.

After birth, therapy begins with ventilation of the baby's lungs. The only one effective method To get rid of the hernia there will be an operation. Emergency intervention is carried out in case of infringement and internal bleeding. Planned surgery performed in 2 stages. In the first, an artificial ventral hernia is created to move organs, and in the second, it is eliminated with drainage of the pleural cavity.

PAfter surgery there is a high probability of complications:

Are common- fever, difficulty breathing, dehydration and swelling.
WITHabout the sidesGastrointestinal tract- intestinal obstruction.
WITHon the side of the respiratory system- pleurisy, swelling and inflammation.

Relapse of the disease after surgical removal more often occurs after removal of paraesophageal hernias. To prevent the recurrence of the pathology, the child must be provided proper nutrition, the feeding regimen is prescribed by the doctor. IN early period rehabilitation, the child is constantly under artificial ventilation.

Undesirable consequences of surgery occur in 15-25% of cases.

Prevention

Pregnancy planning and implementation certain rules during pregnancy - this is the main prevention of congenital pathologies. Before conception, it is important for a woman to rehabilitate systemic pathologies, give up bad habits and undergo a course of vitamin therapy.

INperiod of planning and gestationrecommended:

minimizationstressfulsituations, and yoga, meditation, breathing exercises, visiting a psychologist;
balanced and good nutrition , And the best option there will be a diet according to a specially created program, depending on the individual needs of the body;
moderate physical activity , regular hiking, healthy night's sleep;
complete cessation of bad habits, namely drugs, tobacco, alcohol and energy drinks.

An important condition for prevention congenital anomalies There will be regular visits to the gynecologist and other doctors when your health changes for the timely detection of any abnormalities.

Congenital pathologies have recently become more common. One of these developmental anomalies is congenital diaphragmatic hernia in children, which always entails surgical intervention. This is due to the fact that, as a rule, general state children at birth are difficult, and the risk of death of a child in the first days of life or even hours is very high. To know more, let's consider what congenital diaphragmatic hernia in children is, symptoms, treatment, diagnosis of this disease.

Causes of development of diaphragmatic hernia in children

Not fully understood, most likely this is due to the deterioration of the environmental situation, large quantity stressful situations, presence of foci chronic infections in expectant mothers and many other factors. The risk of congenital diaphragmatic hernia in children with a difficult pregnancy with the development of toxicosis and the threat of miscarriage is especially high. Bad habits in the mother (smoking, alcohol abuse), a tendency to constipation are of no small importance in the occurrence of this pathology. All these factors lead to improper formation of organs in the fetus.

Congenital diaphragmatic hernia, its types and forms

Hernias come in three forms: hiatal hernia, hiatal hernia proper, and anterior hernia. The time when a diaphragmatic hernia appears, the symptoms and their severity are different, it all depends on the size of the defect. An anterior hernia rarely reveals itself in the neonatal period and the first months of a baby’s life. More often this happens in early school age.

The hernias themselves have two types:

1. True. They occur more easily, have a hernial sac (capsules), and the hernia itself is not very mobile.

2. False. With them the situation is more complicated. They do not have a hernial sac; the abdominal organs freely penetrate into the chest cavity, compressing the lungs, heart, and mediastinum. This leads to disruption of their function. This movement occurs in utero. At birth, the general condition of children with false diaphragmatic hernias is extremely severe. If timely assistance is not provided, they die in the delivery room or during transportation to specialized departments.

How do congenital diaphragmatic hernias manifest in children?

Clinical picture depends on how big the defect is. If the hernia is large, and also false, then it manifests itself immediately after birth or in the first days of the baby’s life. The first sign is vomiting that occurs after feedings or between them. On examination, the child’s stomach is sunken and the chest is bulging. The child's skin is bluish and there is shortness of breath. The condition of the newborns is extremely serious; there are signs of intoxication, cardiovascular and respiratory failure. This occurs due to compression of the chest organs. Intestinal obstruction develops, and children may have no stool.

If the defect is not very large, then it reveals itself late. The first signs of congenital pathology appear when babies begin to grow rapidly. This is due to the fact that there is no longer enough space for a hernia in the chest cavity. Children complain of periodic aching pain in the abdomen and chest, worse after eating. They have poor appetite, There is constant feeling chest tightness, heartburn, belching after eating. Children may fall behind physical development. Examination reveals gastritis, peptic ulcer, due to this, blood may appear in the stool. With a long process, children develop chronic Iron-deficiency anemia. If the diagnosis is not made in time, the hernial sac is pinched, then signs of cardiac and respiratory failure increase, and intestinal obstruction develops. True hernias most often manifest themselves in such a clinic.

Diagnosis of congenital diaphragmatic hernia in children

The main emphasis is on identifying this developmental anomaly in utero by conducting an ultrasound examination of the fetus. If a diagnosis of a diaphragmatic hernia has not been made, then at the slightest suspicion of it, it is necessary to take an x-ray of the abdominal and thoracic cavity, after first inserting a probe into the stomach. This will allow you to determine not only the defect itself, but also the location of the stomach.

How to treat a diaphragmatic hernia?

Treatment for diaphragmatic hernia is only surgical. Previously, it was believed that it should be carried out immediately after birth, but now it has been proven that a short delay (no more than a few days) allows the child to adapt to extrauterine living conditions. But such children need to be helped in the delivery room. It involves inserting a probe into the stomach, this will prevent overstretching of the intestinal loops and further compression of the chest organs (heart, lungs). As a rule, such babies need artificial ventilation lungs, and therefore it is advisable to intubate them immediately after birth.

There is evidence of correction of the defect antenatally (in utero). But very few such operations have been carried out in the world.

When the diagnosis is made at school age, then in addition surgical treatment therapy is carried out concomitant diseases: gastritis, peptic ulcer, pancreatitis.

Prevention of complications

Is concluded timely diagnosis even during pregnancy. If this fact is established, then the woman should give birth in specialized institution, where the baby can receive timely assistance immediately after birth.

Prevention of the development of diaphragmatic hernia in children

It is necessary to create the maximum protective regime for a pregnant woman. Good nutritious nutrition is the key to baby’s health. Future mom shouldn't be nervous. Her work cannot in any way be associated with harmful factors: noise, cold, heavy lifting, contact with chemicals, dust, ionizing radiation. Sanitation of foci of chronic infections is mandatory even before conception.

Congenital diaphragmatic hernias are common, but often the diagnosis is made late, which entails a lot of complications. Therefore, in maternity hospital Newborn children need to be treated very carefully.

Diseases digestive system are very common, but their typical symptoms do not always indicate a problem with this particular group of organs. Ailments often arise due to a violation of the elasticity or integrity of the thin muscular septum - the diaphragm, as a result of which hernia formations are formed. This disease is dangerous, especially if left unattended and without medical assistance. 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 muscular plate, the topography of which allows it to clearly distinguish between the thoracic and abdominal cavities of the human body. When it comes to a hernia, this means that organs or parts thereof emerge from 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 care this will lead to extremely disastrous consequences.

Diaphragmatic hernia is a dangerous disease that requires immediate medical care

The 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 types of diaphragmatic hernias are distinguished according to different signs.

Depending on the nature of the displacement of the abdominal organs, 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 a 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 into chest area, being located as if parallel to the esophageal tube;
mixed type.

Based on the differences in the location of the hernial orifice, 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 Larrey’s triangle, the junction of the sternum 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 organ protrusion:

left-sided (in addition to the stomach, a thin and colon, liver or spleen);
right-sided (affects the liver and part of the large intestine);
bilateral hernia (the most complex cases).

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

Post-traumatic

This group is directly related to the events that led to mechanical damage diaphragm. It could be injuries various kinds, falls from a height, injury due to compression of the body during an accident, etc. Often in such situations, the result is 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 eating, less intense than with acute form, and such a hernia is not diagnosed immediately;
strangulated hernias are rare; their appearance is accompanied by sudden painful sensations in the abdomen and chest area.

Non-traumatic

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

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

Specialist's note: the most common hernia is considered to be in the area of the esophageal opening - it is 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 located in the area may be subject to such displacement. in good condition in the abdominal cavity.

Causes

Doctors name both a number of physiological reasons for the occurrence of a hernia, and a list of factors that create favorable conditions, a “platform” for the active development of the problem.

In children

Mechanisms of formation congenital pathology have not been fully established, so it is difficult to name the exact reasons. Under the influence of certain factors, during the movement of the intestines into the abdominal cavity and the formation of the diaphragm plate (from the 10th to 12th weeks of pregnancy), a malfunction occurs, due to which the muscle plate does not completely fuse. Diagnosis frequency birth defect this kind is one case in 3 thousand newborns.

Video about diaphragmatic hernia in newborns

In adults

In adults provoke similar condition may specific situations, namely:

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

In adult patients symptomatic manifestations partly different:

an unpleasant sensation similar to heartburn, the intensity of which increases significantly when the body is tilted forward;
eating is difficult, since after swallowing there is a feeling of a lump stuck in the esophagus;
constant belching;
bloating;
painful sensations in the lower 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 regular fetal ultrasound if the hernia is large enough. Diagnosis is possible after the end of the first trimester of pregnancy.
	Magnetic resonance imaging	If during an ultrasound there is a suspicion of the development of a hernia (due to noticeable displacement of organs), then the mother may be prescribed an MRI study to obtain a clearer picture.
Diagnosis in children and adults	X-ray examination	On the overview x-ray In the chest and abdominal cavities, both the atypical protrusion of the diaphragm and the hernia itself can be clearly visible.
	pH-metry	This method necessary to determine the current level of acidity in the elements of the digestive system. If an increased level is noted in the esophagus, 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 mucous membrane.

Treatment

In children

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

Doctor’s advice: do not be afraid and refuse surgery for your baby, since the sooner the defect is eliminated, the less likely the emergence of dangerous complications.

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

Diaphragmatic hernia in the fetus

If a hernia in a child was discovered during the prenatal development stage, the expectant mother is placed under constant medical supervision. This is due to the fact that with such a diagnosis there is a fairly high risk fatal outcome. If the baby experiences acute respiratory failure due to improper placement of organs, an urgent caesarean section is required to perform the operation.

Today, doctors practice intrauterine treatment of diaphragmatic hernias - the uterus is opened, and after the problem is eliminated, the child is carried further. This approach is a modern alternative that avoids caesarean section on early stages.

In adults

Treatment is complex and includes the prescription of medications, correction of the nutritional system, as well as surgical intervention.

Drug therapy

Prescribing 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 acidity, painkillers, etc. Treatment always begins with a conservative approach; surgery is prescribed only if it is ineffective and the situation worsens.

Diet

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

the volumes of food consumed should be small so as not to burden the digestive organs;
You can drink drinks only an hour before meals or one and a half hours after meals;
alcoholic, carbonated and artificial drinks should be excluded from the diet;
products should be easily digestible, these can be: corn grits, dietary meat, steamed food, oatmeal, etc.;
You should add dates, nuts, figs or dried apricots to your daily diet;
You need to chew food thoroughly - the eating process should take place slowly;
After eating, you need to wait some time, at least an hour, before going to bed.

Prohibited foods for diaphragmatic hernia (photo gallery)

Bakery products Apples

Visceral massage

Within complex treatment non-strangulated hernias, the so-called visceral massage. The impact on the abdominal area is carried out through tapping and intense pressure. It is very important that the procedure is carried out by a professional, in which case the general condition of the body will improve, blood circulation in the abdominal cavity will be normalized, and displaced organs will return to their places. This method is used as a temporary method to alleviate the condition and prevent strangulation 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 in size or there is infringement of organs that are located in the hernial sac or passed through the opening of the diaphragmatic plate into the chest cavity. The essence of the operation is excision of the internal sac or suturing of the defect (hole) with preliminary repositioning of the organs in their places. If the hole is very large, then the technique of applying a “patch” made of special materials of synthetic origin can be used.

Folk remedies

Folk remedies for this disease can also be used, but only as a supplement to traditional treatment. They help suppress some symptoms: reduce the intensity 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 consumed warm every day, half a glass in the morning and evening after meals;
herbal decoction made from leaves peppermint, coltsfoot, dandelion, grass cinquefoil, shanta and angelica root. All elements are mixed in equal proportions (one hundred grams of each). To prepare the decoction, add one tablespoon to two glasses of water and then simmer 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 to take 15 drops of tincture mixed with sugar or a small amount of water daily;
cumin seed tea. To make it, grind one tablespoon of cumin grains, then pour 200 ml of boiling water over them 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. The tea should be taken warm and 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, all you need is A complex approach and patient compliance with all doctor’s recommendations. The main thing is to detect the problem in time and prevent complications from developing.

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 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;
passing 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. Possible appearance secondary pathologies associated with poor circulation in internal organs, deficiency of surfactant (a substance that triggers the breathing process after cutting the umbilical cord) and blood poisoning. At large sizes hernial protrusion, symptoms associated with displacement occur 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 hiatal hernia.
Relocation of the gallbladder to 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 to the 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 promotes disruption of innervation caused by inflammation 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. Appears in the background pathological expansion 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, therefore, if a defect is detected during intrauterine development, delivery is carried out in 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 cause 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 typical sliding hernias, accompanied by a hit 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.