Updated: 12/25/2021

Congenital Diaphragmatic Hernia

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
0%
0%
Evidence
2
0
0
Topic
Images
https://upload.medbullets.com/topic/121775/images/snap2.jpg
https://upload.medbullets.com/topic/121775/images/scaphoid.jpg
https://upload.medbullets.com/topic/121775/images/xray.jpg
  • Snapshot
    • A newborn infant girl is evaluated 2 hours after birth for signs of trouble breathing. The patient was born via an uncomplicated vaginal delivery at 39 weeks of gestation to a 32-year-old mother. The girl's APGAR scores were 9 at 1 minute of life and 10 at 5 minutes after delivery, with a score of 2 for respiration with a vigorous cry at both time points. Her temperature is 96.9°F (36.1°C), pulse is 168/min, and respirations are 58/min. On physical examination, the patient's point of maximal impulse is markedly displaced to the right and lung sounds are absent on the left side. A chest radiograph is obtained and shown in the image.
  • Introduction
    • Overview
      • a congenital diaphragmatic hernia occurs due to congenital defects in the diaphragm, causing bowel to protrude through the diaphragm into the thorax
  • Epidemiology
    • Incidence
      • 1 in 3000 newborns
    • Demographics
      • 90% of patients present in the neonatal period or within 1 year of age
    • Location
      • commonly presents on the left posterolateral side
  • ETIOLOGY
    • Pathophysiology
      • muscular entities and pleuroperitoneal membrane of the diaphragm fail to develop normally
        • diaphragm develops between 4-12 weeks of gestation
          • Bochdalek hernia
            • failure of pleuroperitoneal membrane closure in utero causes a defect in the posterior attachment of the diaphragm
          • Morgagni hernia
            • failure of formation of the anteromedial portion of the diaphragm, where the septum transversum and the anterior-inferior thoracic wall intersect
        • results in displacement of bowel into the thorax
  • Presentation
    • Symptoms
      • dyspnea and/or respiratory distress
      • cyanosis
        • occurs within the first 24 hours of life if neonatal onset
      • chest tightness or fullness
    • Physical exam
      • ↓ breath sounds on the affected side
      • bowel sounds in the thorax
      • displaced point of maximal impulse
      • cyanosis
      • scaphoid abdomen
        • due to herniation of abdominal contents into thorax
  • Imaging
    • Chest radiograph
      • findings
        • bowel and stomach are present in the chest cavity
        • shifting of the mediastinum to one side
  • Treatment
    • Medical
      • resuscitation with ventilatory support
        • indications
          • respiratory distress
        • modalities
          • conventional mechanical ventilation
          • high-frequency oscillatory ventilation (HFOV)
      • ECMO (extracorporeal membrane oxygenation)
        • indications
          • reserved for patients who fail to improve with both conventional mechanical ventilation and HFOV
      • nasogastric tube for decompression
    • Surgical
      • surgical repair of the hernia
        • definitive treatment
  • Complications
    • Small bowel obstruction
      • risk factors
        • late-presenting congenital diaphragmatic hernia in neonates
        • left-sided hernia associated with ↑ bowel complications (liver protects from herniation on the right side)
        • adhesions from surgical repair of hernia
      • treatment
        • surgery for small bowel obstruction repair

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
Cards
1 of 0
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (2)
EXPERT COMMENTS (3)
Private Note