Fatur Reyhan Muradi

Congenital
Diaphragmatic
Hernia
Fatur Reyhan Muradi | 150100140
Case Report
• The baby girl is born normally, after birth the patient is congested then taken to
the midwife and said there is no problem with the patient. 2 days before being
admitted to the hospital, the patient was only treated at home, as long as at
home the patient looked congested, lacked breastfeeding, inactivity, fever (-),
vomiting (-), defecate (+), urination (+). 1 day before entering the hospital, the
patient's body turned blue, did not want to breastfeed, tightness, inactivity,
because the patient's condition did not improve, the patient's parents then took
the patient to the hospital.
• Neonatal months (42 weeks) according to the period of pregnancy the weight
of the baby is born 3900 grams + respiratory distress + Hernia diaphragmatic
hernia
Case Report
• A male patient, born at term by vaginal delivery with difficult extraction, weighing 3575 g, with Apgar score 3/7 in the
first and fifth minutes of life, which required positive pressure ventilation (PPV) at birth.
• The newborn was born well and evolved with sudden respiratory distress, requiring ventilation. The newborn should
be examined for murmurs, to be conducted as a congenital and/or abdomen dug present for diaphragmatic hernia,
being intubated immediately once he pre- sents any clinical diagnostic. Approximately twenty minutes after birth,
the newborn had a sudden respiratory dysfunction evolved into a prolonged cardiac arrest. The newborn was
intubated and received cardiac mas- sage and resuscitation. He was then taken to the Inten- sive Care Unit and
carried out a chest radiograph, which showed atelectasis of the right lung and left diaphragmatic hernia. He
developed acute renal failure and was not in condition to perform peritoneal dialysis, as well as surgical correction
of the hernia. He died in the sec- ond day of life.
• we observe small bowel in the chest through a posterolateral hole, shifting the mediasti- num to the right. It is also
possible to observe in this Figure the presence of a tube on the right lower hemi- thorax when the newborn was at
supine position, this tube was necessary to remove pus from the intrathoracic space due to the inflammation
mechanism in the area.
X-ray
Conclusion
The diagnosis in the pre-natal period induces to a better

prognosis, since the birth in a center well equipped will made
necessary interventions, minimizing neonatal complications
and, thus, optimizing the chances of survival. The clinical
importance overlaps the X ray in case of no diagnosis with
prenatal care, it is very important for physicians to be alert for
signs that show a possible case of diaphragmatic hernia.
Definition
A diaphragmatic hernia is defined

as a communication between the
abdominal and thoracic cavities
with or without abdominal
contents in thorax.
• Congenital
Etiology • Traumatic
Types • Retrosternal (Morgagni)

• Posterolateral (Bochdalek)
Congenital Diaphragmatic Hernia
EPIDEMIOLGY ASSOCIATED ANOMALIES

• Incidence: 1/2000- 1/5000 • CNS lesions
live births • Omphalocele
• M:F – 1:2 • Esophageal atresia
• Left side more common • Cardiovascular lesions
(85%)
• Bilateral <5%
Signs And Symptoms
• Respiratory distress (tachypnea, grunting, cyanosis)

• Scaphoid abdomen
• Increased chest wall diameter
• Bowel sound heard in chest with decreased/absent breath
sounds on side of hernia
• Shifting of apex beat contralateral side of hernia
Diagnosis
• Prenatal USG at 16-24 WOG: polyhydramnios, chest mass,

mediastinal shift, gastric bubble in thoracic cavity
• After delivery: Chest X Ray with nasogastric tube
• Barium study
• Echocardiography
• Amniocentesis
Radiology
• Chest X-ray images usually help with diagnostics.

Lateral view often shows intestines entering through
the posterior part of the diaphragm. Sometimes
congenital cystic lesions of the lung can produce the
same radiographic picture.
• The difference with diaphragmatic hernias can be

established by postnatal ultrasound or contrast
injection into the stomach or umbilical artery catheter
to recognize the intestine above the diaphragm. In
older children, with non-typical symptoms, contrast
gastrointestinal examination is usually required.
Ultrasound and fluroscopy help distinguish elevation
from actual hernias. CT scans are needed to rule out
pneumonia or complications of effusion.
Differential Diagnosis
• Cystic lung lesion( pulmonary sequestration, cystic adenoid

malformation Pulmonary sequestration
• Eventration of Diaphragm
• Bronchogenic cyst
• Neurogenic Tumors
• Primary Lung Sarcoma
Treatment
• Keep the neonate warm. If you need ventilation therapy with mild pressure.
Install a gastric sonde and do continuous sucking to prevent intestinal
distension. It can also be checked for pH and blood gas.
• Elective surgery is necessary to prevent complications. Emergency measures
are also necessary if heart-lung insufficiency is found in neonates. Hernia
repositioning and closure of the defect give good results.
• Generally the correction is done through laparotomy. In the post-operative
state, the patient needs to be given breathing assistance with a ventilator, as
well as checking the pH and frequency of blood gas.
Prognosis
Prognosis is very dependent on the condition of the lungs.

Mortality reaches 50% in neonates who on the first day of birth
show severe respiratory distress syndrome. In cases with mild
respiratory distress syndrome and neonates can reach the age
of the first 3 days, generally can be helped 100%. Poor
prognosis if the lungs are very hypoplastic and with
resuscitation there is no improvement in blood oxygen
saturation.

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Fatur Reyhan Muradi

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Congenital

The diagnosis in the pre-natal period induces to a better

A diaphragmatic hernia is defined

Types • Retrosternal (Morgagni)

EPIDEMIOLGY ASSOCIATED ANOMALIES

• Respiratory distress (tachypnea, grunting, cyanosis)

• Prenatal USG at 16-24 WOG: polyhydramnios, chest mass,

• Chest X-ray images usually help with diagnostics.

• The difference with diaphragmatic hernias can be

• Cystic lung lesion( pulmonary sequestration, cystic adenoid

Prognosis is very dependent on the condition of the lungs.

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