Congenital Diaphragmatic Hernias

Question 1

Congenital Diaphragmatic Hernias types

Answer 1

1- Posterolateral (Bochdalek) Left-sided 85% Right-sided 13% Bilateral, rare, often fatal

2-Anterior (Morgagni)

3- Hiatus

Question 2

Congenital Diaphragmatic Hernias incidence

Answer 2

1 in 2000 to 5000 live births Presents within hours of life although some cases of delayed presentation M=F >10% are associated with other congenital anomalies Prenatal diagnosis common

Question 3

Congenital Diaphragmatic Hernias

Associated

Answer 3

• Left-sided: small bowel, large bowel, stomach, and solid viscera (spleen, left lobe of liver) herniate into thorax
• Right-sided: liver, large bowel herniate into thorax Pulmonary hypoplasia Pulmonary HTN

Question 4

Congenital Diaphragmatic Hernias clinical manifestations

Answer 4

Early respiratory distress Cyanosis Scaphoid abdomen Prenatal diagnosis
-Decreased air entry ± bowel sounds in the chest Displaced heart sounds
😱😱 It is noteworthy that in some infants, the first 24 to 48 hours after birth are often characterized by a period of relative stability with high levels of PaO 2 and relatively good perfusion. This has been termed the “honeymoon period” and is often followed by progressive cardiorespiratory deterioration.

Question 5

Congenital Diaphragmatic Hernias investigation

Answer 5

Prenatal US/MRI ABG CXR (bowel loops in hemithorax, shifted heart) Echocardiography Genetic consultation if warranted

Question 6

Treatment

Answer 6

🌚🌝Stabilisation:
Intubate Orogastric suction Period of respiratory stabilization due to associated pulmonary hypoplasia (may require extracorporeal membrane oxygenation)
🌚🌝 Surgical repair after stable by hernia reduction and closure of diaphragmatic defect open vs. thoracoscopic vs. laparoscopic with or without prosthetic or muscular patch depending on size of defect