Diaphragmatic hernia and diaphragm eventration occur due to genetic or subsequent damage. Diaphragmatic eventration is also known as diaphragmatic elevation.
These diseases, which are caused by developmental disorders or as a result of injuries, affect the development of the baby. These diseases, which manifest themselves with symptoms such as breathing difficulties and lung infections, can be randomly diagnosed in the routine control of another illness.
Clinical competence and doctor control are essential in the treatment of both diseases. So what are the causes of diaphragmatic hernia and diaphragm eventration, how is it diagnosed, and in whom is it seen? Here are the answers.
What does Diaphragmatic Hernias / Eventration Mean?
Cavities such as the thoracic and abdominal cavities in our body prevent the intertwining and displacement of various organs. The deterioration of these cavities and the dislocation of different structures within the body due to various reasons is called a hernia. The diaphragm is a muscle and fiber structure that separates the abdominal cavity from the thoracic cavity. It is similar to other cavities in the body in terms of its functions. It ensures that the structures do not dislocate and stay fixed.
Any disruption or opening in the diaphragm causes organs in the abdominal cavity to move toward the chest cavity. This condition is called a diaphragmatic hernia. On the other hand, diaphragmatic eventration is a sporadic disease usually noticed while examining another condition. This disease usually occurs on the left side of the diaphragm. Diaphragm eventration or elevation, the cause of which is not known precisely, may develop congenitally or after birth.
Diaphragmatic eventration, defined as the permanent elevation of a part or all of the diaphragm muscle, usually occurs due to weakness or paralysis of the diaphragm muscle or fibers.
How is the Diaphragmatic Hernia / Eventration Treated?
Diaphragmatic hernia treatment is a surgical intervention. During the surgery, the organs are brought to their original position, and the defect in the diaphragm is repaired. The patient may need to receive respiratory support after the surgery.
The treatment success depends on the development rate of the baby's lung. Babies with sufficiently developed lungs are more likely to survive. Although surgery is not an urgent treatment method for diaphragmatic hernia, it is a priority.
Treatment should not be delayed in trauma-related hernias. In situations where the baby needs respiratory support right after birth, we understand that the lungs are insufficient, and there is a risk of not being saved even with surgery. It means that the anomaly is severe. The life-threatening risk is exceptionally high in babies with underdeveloped lungs and heart anomalies.
In the presence of diaphragm eventration, adults experience minimal respiratory distress. In contrast, children or newborns experience much more severe difficulties, and this is related to underdeveloped lungs.
For this reason, the technique of folding, called plication, is applied in the eventration treatment. After the operation, the patient is followed up and receives respiratory support if necessary.
Plication surgery aims to replace the diaphragm to its original position and fix it. With this intervention, we prevent the movement of the diaphragm and correct its position. Thus, the slippage of the internal organs into each other is eliminated, and the respiratory capacity of the lungs is increased. We recommend light exercises and healthy living habits to improve lung performance.
How is Diaphragmatic Hernia / Eventration Diagnosed?
Congenital diaphragmatic hernia can be diagnosed during embryonic life. It is possible to understand whether there is a diaphragmatic hernia in the baby with ultrasound, which is one of the routine controls of pregnancy. For this, the baby must be at least 18 weeks old.
A diaphragmatic hernia that develops in adults can be diagnosed by radiological examinations such as USG, chest X-ray, and CT.
What are the Symptoms of Diaphragmatic Hernias / Eventration?
The most common symptoms of a diaphragmatic hernia are:
- Difficulty in breathing
- Decrease or disappearance of breath sounds
- Bowel sounds from the chest area
- The collapse of the abdomen
- Frequent recurrent lung infections
Common symptoms of diaphragm eventration are as follows:
- Advanced respiratory failure
- Shortness of breath
- Lack of oxygen in the blood (hypoxemia)
- Abdominal swelling
- Weight loss
- The collapse in the lower part of the chest
- Fullness in the abdomen
- Difficulty breathing while bending over and sleeping
- Constantly having to stand up and lie down
Who has Diaphragmatic Hernias / Eventration?
Diaphragmatic hernia can occur congenitally or later. In subsequent hernias, there is usually trauma. However, if the diaphragmatic hernia is in children, it is usually congenital.
For this reason, correct diagnosis while embryonic life ensures early disease diagnosis. Diaphragmatic hernia, if formed prenatally, is caused by defects in the diaphragm's development. The subsequent fusion of the individual parts completes the normal development of the diaphragm. In babies with a hernia, on the other hand, there are defects in the fusion part during the development of the diaphragm, and the diaphragm does not fully integrate. The exact cause of hernia is unknown, but approximately 30% of individuals with the disease have chromosomal disorders.
Genetic factors affect this congenital or acquired disease. It is also common in individuals over the age of 50. It is more likely to occur in women and obese people.
Diaphragmatic eventration is rare in adults but more common in males. Just like diaphragmatic hernia, the cause of which is unknown can occur congenitally or later.
Diaphragm eventration is divided into paralytic or non-stroke; it occurs more frequently in people with prior heart surgery, tumors and trauma, muscle nerve diseases, and tuberculosis. However, the general causes of the disease and which patients are at risk are still unknown.