CONGENITAL

DIAPHRAGMATIC HERNIA
GROUP: IM-650

DR. AJOKPEROGHENE INIOVORUA 06/11/2022

DEFINITION

Congenital diaphragmatic hernia (CDH) occurs when there is a hole in the diaphragm,
which is the the thin sheet of muscle seperating the chest from the abdomen.
When this gap forms during a fetus’s development in the womb, the bowel, stomach
or even the liver can move into the chest cavity.
It is associated with pulmonary hypoplasia.
CHD occurs in 1 in every 2500
births. It is 80 % left sided.
CHD
Etiology

The cause of CDH is unknown.

Typically congenital diaphragmatic hernias are associated with genetic conditions
such as congenital heart defects like aortic arch hypoplasia, ductus arteriosus septal
defects etc.
Other associative causes are trisomies 13,18 and 21.
Congenital Diaphragmatic Hernia
Pathophysiology

Most frequently caused by failure of one or both of the pleuroperitoneal membranes to

close the pericardioperitoneal canals.
Thus, the peritoneal and pleural cavities are continuous with one another along the
posterior body wall.
This allows abdominal viscera to enter the pleural cavity, pushing the lungs and heart
In 85 % to 90 % of cases, the hernia is on the left side.
Congenital Diaphragmatic Hernia
Types of CDH

There are 2 types of Congenital Diaphragmatic Hernias

Bochdalek Hernia- which involves an opening on the left side of the chest.
Morgagni Hernia : which involves an opening on the right side of the chest.
BOCHDALEK
HERNIA
-Most common type of hernia
(left sided hernia)
-Makes up 90% of all cases
-Slightly more common in boys
-Shifting the of the heart and
the mediastinal to the left,
causing cardiac compression.
MORGANI
HERNIA
-Uncommon type of hernia
(right)
-Makes up 2 % of all cases.
-More common in girls
-Signs and symptoms may or
may not be present.
Congenital Diaphragmatic Hernia
Signs & Symptoms

Rapid and shallow breathing

Tachycardia
Cyanosis
Paradoxical breathing
Breath sounds absent on the affected side.
Bowel sounds heard in the chest
Concave abdomen that feels less full when touched
Congenital Diaphragmatic Hernia
Diagnosis

Typically can be diagnosed at prenatal stage with the use of USG (40-60 %). It can be
diagnosed typically around 21-24 weeks of gestation.
Classic triad- cyanosis, dyspnea, apparent dextrocardia
Scaphoid abdomen
Bulging chest
Variable presentation
Amniocentesis
Congenital Diaphragmatic Hernia
Diagnosis Cont’d

After birth :
A chest xray nasogastric tube in situ is needed to confirm the diagnosis
CHD Cont’d
Management of CHD

Before birth :
Antenatally diagnosed case should be delivered in well equipped hospital
Termination of pregnancy may required in some cases diagnosed with chromosomal
anomalies
Fetal surgeries
Tracheal balloon obstruction
Maternal corticosteroids
Congenital Diaphragmatic Hernia
Management of CHD

After birth :
Initial mgt : Careful protocols of respiratory assistance should be implemented.
(Prolonged BVM should be avoided) (immediate intubation-low volume, low PIP, and
high frequency ventilation)
Ventilation strategies : ECMO (Extracorporeal membrane oxygenation)

Prolonged bag and mask are contraindicated.

I hope we’ve all
been able to learn a
thing or two about
CHD!
Thank You!