DIAPHRAGMATIC HERNIAS

Diaphragmatic Hernias

Definition

• Diaphragmatic hernia is a condition where there is a protrusion of an organ or tissue through a defect in the diaphragm.

Types

• Congenital Diaphragmatic Hernia (CDH): A developmental defect of the diaphragm, usually occurring on the left side.
• Acquired Diaphragmatic Hernia: A hernia that develops later in life due to injury, surgery, or disease.
• Hiatal Hernia: A type of acquired diaphragmatic hernia where the stomach protrudes through the esophageal hiatus.
• Foramen of Bochdalek Hernia: A congenital diaphragmatic hernia that occurs through the posterior part of the diaphragm.
• Foramen of Morgagni Hernia: A congenital diaphragmatic hernia that occurs through the anterior part of the diaphragm.

Pathology

• Pathogenesis: The diaphragm is a dome-shaped muscle that separates the chest cavity from the abdominal cavity. A defect in the diaphragm can occur during embryonic development or later in life due to injury or disease.
• Anatomy: The diaphragm consists of the central tendon, the crura, and the peripheral muscle fibers. The crura are two tendinous structures that attach the diaphragm to the spine.
• Blood Supply: The diaphragm is supplied by the inferior phrenic arteries and the musculophrenic arteries.
• Nerve Supply: The diaphragm is innervated by the phrenic nerves.

Causes

• Congenital: Embryonic developmental defect.
• Acquired: Trauma, surgery, disease (e.g., tuberculosis).
• Increased Intra-Abdominal Pressure: Obesity, pregnancy, ascites.

Clinical Features

• Symptoms: Abdominal pain, dyspnea, nausea, vomiting.
• Signs: Abdominal distension, tenderness, guarding.
• Physical Examination: Inspection of the chest and abdomen.

Investigations

• Chest X-ray: Demonstrates the diaphragmatic defect and the size of the hernia.
• CT Scan: Visualizes the diaphragm and the contents of the hernia.
• Ultrasound: Assesses the size of the hernia and the presence of any complications.

Complications

• Strangulation: The herniated contents become trapped, leading to ischemia and necrosis.
• Obstruction: The herniated contents become entrapped, leading to bowel obstruction.
• Respiratory Compromise: The hernia can compromise respiratory function.

Management

• Conservative: Observation and supportive care for small hernias.
• Surgical: Repair of the diaphragmatic defect and reduction of the hernia contents.
• Emergency: Repair of the hernia and resection of any compromised bowel.

Treatment

• Surgical Repair: The goal is to close the diaphragmatic defect and prevent further complications.
• Approach: Open or laparoscopic repair, depending on the size and location of the hernia.
• Technique: Closure of the diaphragmatic defect, reduction of the hernia contents, and repair of any adjacent organs.

Indications for Surgical Repair

• Symptomatic Hernia: Presence of symptoms, such as abdominal pain and dyspnea.
• Large Hernia: Hernia size greater than 5 cm.
• Strangulation or Obstruction: Complications of the hernia.
• Respiratory Compromise: Significant impairment of respiratory function.

Homoeopathic Therapeutic Medicines

• Arnica: For pain and swelling.
• Belladonna: For pain and inflammation.
• Nux Vomica: For digestive symptoms and nausea.
• Pulsatilla: For digestive symptoms and abdominal pain.