What Is a Diaphragmatic
The diaphragm is a dome-shaped muscular barrier between the chest
and abdominal cavities. It separates your heart and lungs from your abdominal
organs (stomach, intestines, spleen, and liver).
A diaphragmatic hernia occurs when one of your abdominal organs
moves upward into your chest through a defect (opening) in the diaphragm. This
kind of defect can be present at birth or acquired later in life. It’s always a
medical emergency and requires prompt surgery to correct.
What Are the Causes of a
A congenital diaphragmatic hernia (CDH) is due to the abnormal
development of the diaphragm while the fetus is forming. A defect in the baby’s
diaphragm allows one or more of their abdominal organs to move into the chest
and occupy the space where their lungs should be. As a result, the baby’s lungs
can’t develop properly. In the majority of cases, this affects only one lung.
An acquired diaphragmatic hernia (ADH) is usually the result of a
blunt or penetrating injury. Traffic accidents and falls cause the majority of
blunt injuries. Penetrating injuries are usually due to stab or gunshot wounds.
Surgery on the abdomen or chest may also cause accidental damage to your
What Are the Risk Factors
for a Diaphragmatic Hernia?
Most congenital diaphragmatic hernias are idiopathic; their cause
is unknown. However, chromosomal abnormalities have been implicated in about 30
percent of cases.
The following factors may increase your risk of an acquired
injuries due to a traffic accident
procedures on the chest or abdomen
that impact the diaphragm region
What Are the Symptoms of a
The symptoms of a diaphragmatic hernia vary depending on its
cause and severity.
This is usually very severe. In a CDH, it results from the abnormal
development of the lungs. In an ADH, it occurs when the lungs can’t function
Blue Discoloration of the Skin
When your body doesn’t receive enough oxygen from your lungs, it
can make your skin appear blue (cyanosis).
Tachypnea (Rapid Breathing)
Your lungs may try to compensate for the low levels of oxygen in
your body by working at a faster rate.
Tachycardia (Rapid Heart Rate)
Your heart may pump rapidly to try to supply your body with
Diminished or Absent Breath Sounds
This symptom is normally present in the case of a CDH because one
of the baby’s lungs may not have formed properly. The breath sounds on the
affected side will be absent or very difficult to hear.
Bowel Sounds in the Chest Area
This occurs when your intestines move up into your chest cavity.
Less Full Abdomen
Your abdomen may feel less full than it should upon palpation (an
examination of the body by pressing on certain areas).
How Is a Diaphragmatic
Doctors can usually diagnose a congenital diaphragmatic hernia
before the baby is born. An ultrasound examination may reveal the abnormal
position of the abdominal organs in the fetus. The pregnant mother may also
have an increased amount of amniotic fluid (the fluid that surrounds and
protects the fetus).
After birth, the following abnormalities may appear during a
breath sounds on one side of the chest
sounds in chest
“half empty” feeling abdomen
The following tests are usually sufficient to diagnose both a CDH
and an ADH:
scan (uses sound waves to produce images of the thoracic and abdominal cavities
and their contents)
scan (allows for direct viewing of the abdominal organs)
blood gases (takes blood directly from an artery and tests for levels of
oxygen, carbon dioxide, and acidity, or pH level)
How Is a Diaphragmatic
Both congenital and acquired diaphragmatic hernias are surgical
emergencies. Surgery must be performed to remove the abdominal organs from the
chest and place them back into the abdomen. The surgeon will then repair the
In a CDH, surgeons will ideally perform surgery 24 to 48 hours
after the baby is delivered. The first step is to stabilize the baby and
increase its oxygen levels. The surgeon will perform an endotracheal intubation
by inserting a tube into the mouth and down to the baby’s trachea (windpipe).
The other side of the tube connects to a mechanical ventilator (breathing
machine). Once the baby stabilizes, then surgery can occur.
In an ADH, the patient may also need to stabilize before surgery.
Because most cases of ADH are due to injury, there might be other complications
such as internal bleeding. Therefore, the surgery usually happens as soon as
How Can a Diaphragmatic
Hernia Be Prevented?
There is no way to prevent a CDH, but some basic preventive
measures can help you avoid an ADH:
activities that make you prone to blunt injuries to the chest or abdomen, such
as contact sports.
caution around sharp objects, such as knives and scissors.
What Is the Long-Term
The outlook for a diaphragmatic hernia depends on how damaged your
lungs are. According to the Johns Hopkins Children’s Center, the survival rate
for CDH is more than 80 percent. The survival rate for an ADH correlates
directly with the type of injury and its severity.