Diaphragmatic Hernia

A diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity due to a defect within the diaphragm. Diaphragmatic hernia is commonly a congenital phenomenon; however, acquired cases also occur. The reported incidence of diaphragmatic hernia is approximately 0.8 to 5 out of 10,000 live births. Acquired diaphragmatic hernias typically occur following blunt or penetrating trauma, which results in a rupture of the diaphragm, accompanied by herniation of abdominal content; however, acquired diaphragmatic hernias can also occur spontaneously or due to iatrogenic causes. Acquired diaphragmatic hernia is rare but can be life-threatening, resulting in bowel incarceration and strangulation with an overall mortality rate of up to 31%. Congenital diaphragmatic hernia is a developmental defect of the diaphragm that results in the herniation of abdominal viscera into the chest cavity. Neonates with congenital diaphragmatic hernia usually present with respiratory distress early in the first few hours of life. The respiratory distress associated with the congenital diaphragmatic hernia may be mild. Occasionally, the accompanying respiratory distress is so severe that it can be life-threatening. With antenatal diagnosis and improved neonatal care, survival has been remarkably improved, but a notable risk of morbidity and mortality remains in infants with congenital diaphragmatic hernia. Diaphragmatic injury is rare, complicating less than 1% of all patients with trauma. However, the incidence includes up to 3% of all abdominal injuries. Isolated diaphragmatic injuries are uncommon and are usually reported in the context of complicated abdominal and thoracic injuries. Notwithstanding the probability of an obvious herniated abdominal viscera in the thoracic cavity in the chest radiographs, the subtle cases should not be underestimated. Therefore, a high index of suspicion is strongly recommended to avoid the debilitating morbidity associated with delayed and missed diagnosis.