فتق الحجاب الحاجز

Diaphragmatic Hernia

• Diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity due to a defect in the diaphragm.
• Congenital diaphragmatic hernias are developmental defects in the diaphragm, leading to herniation of abdominal organs into the chest cavity.
• Acquired diaphragmatic hernias are typically caused by trauma (blunt or penetrating), and less frequently by spontaneous events or iatrogenic causes.
• Congenital diaphragmatic hernia usually presents in newborns with respiratory distress in the first few hours of life. This distress can range from mild to life-threatening.
• Acquired diaphragmatic hernias may present with a variety of symptoms, including respiratory problems, abdominal pain, and other symptoms related to the affected organs.
• Treatment strategies vary depending on the type and severity of the hernia. For acquired hernias, surgical repair is typically required to correct the defect and reduce the herniated organs.
• Prenatal diagnosis of congenital diaphragmatic hernia can be made using ultrasound.
• Postnatal diagnosis can be made with chest X-rays which show the herniation of the abdominal contents into the thorax.
• In congenital diaphragmatic hernias, there's a risk of morbidity and mortality relating to abnormal lung development and persistent pulmonary hypertension.
• In cases of acquired diaphragmatic hernias, survival rates are generally good with improved neonatal care and proper treatment protocols.

Etiology

• Acquired diaphragmatic hernias are most often caused by blunt or penetrating trauma.
• Congenital diaphragmatic hernias are caused by failure in the normal embryological development of the diaphragm.

Epidemiology

• Congenital diaphragmatic hernia occurs at a rate of about 2.3 per 10,000 live births. This incidence can vary and is influenced by related factors.
• Acquired diaphragmatic hernias are less common and often associated with other injuries.

Pathophysiology

• Acquired rupture/hernias typically occur at areas of weakness along the embryological fusion planes of the diaphragm in response to trauma.
• There is an increase in pleuroperitoneal pressure that overwhelms the tensile strength of the diaphragm.
• Causes of traumatic acquired diaphragmatic ruptures can include motor vehicle accidents, falls, or penetrating injuries.
• Congenital diaphragmatic hernias arise from incomplete development of the fetal diaphragm during pregnancy, leading to herniation of abdominal organs into the chest cavity.

Diagnosis

• Prenatal diagnosis in up to 60% of cases is possible with routine antenatal ultrasound screening.
• Postnatal patients presenting with symptoms of respiratory distress are screened by chest radiography.

Treatment/Management

• Management of acquired diaphragmatic hernias often involves surgical repair of the defect in the diaphragm using an open abdominal approach.
• In some cases, mesh repair may be necessary depending on the extent of the defect and presence of other complications.
• Treatment of congenital diaphragmatic hernias requires intensive critical care, including potential use of extracorporeal membrane oxygenation (ECMO).

Complications

• Complications associated with diaphragmatic hernias can include respiratory distress, bowel obstruction, and cardiac complications.
• Outcomes and management vary depending on the severity of the hernia and associated injuries.

Evaluation

• Diagnostic process of congenital diaphragmatic hernia includes prenatal and postpartum evaluation using tools to diagnose the hernia.
• Diagnostic studies include chest radiography, ultrasound, computed tomography (CT), and MRI.

Prognosis

• Long term prognosis and outcomes for both acquired and congenital diaphragmatic hernias vary depending on the timing of diagnosis and treatment, severity, and associated complications.

يغطي هذا الاختبار موضوع فتق الحجاب الحاجز، والذي يمثل بروتوكول الأعضاء البطنية إلى التجويف الصدري نتيجة لعيب في الحجاب الحاجز. يتناول الاختبار الفتق الخلقية المكتسبة، وأعراضها، وأساليب علاجها.