Pediatric surgery. Hernia of the diaphragm itself. Complicated false hernia of the diaphragm itself. Clinic (most important)

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Pediatric surgery. Hernia of the diaphragm itself. Complicated false hernia of the diaphragm itself. Clinic (most important)

Lecture notes, cheat sheets

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24. Hernia of the diaphragm itself. Complicated false hernia of the diaphragm proper. Clinic

Congenital defects of the diaphragm, through which the organs of the abdominal cavity move into the chest, usually are of three types: a slit-like defect in the region of the lumbocostal region (Bogdalek's fissure), a significant defect in the dome of the diaphragm and aplasia - the absence of one of the domes of the diaphragm.

clinical picture. In the presence of a slit-like defect in the region of the lumbocostal region (Bogdalek's fissure), an acute course of a false hernia of the diaphragm proper occurs, usually in the first hours or days after the birth of a child.

In most cases, a hernia is manifested by symptoms of increasing asphyxia and cardiovascular insufficiency, which develop as a result of flatulence of the intestinal loops and stomach moved into the chest cavity.

In the first hours of life, intestinal loops and the stomach are filled with gas, their volume increases sharply and the compression of the organs of the chest cavity increases.

With a narrow slit-like defect, the hollow organs are unable to move back into the abdominal cavity on their own.

On the side of the hernia (usually on the left), breathing is sharply weakened or not audible.

In older children, faint noises of intestinal peristalsis are detected. On the opposite side, breathing is weakened to a lesser extent.

Heart sounds are heard clearly, as a rule, dextrocardia is detected.

At the birth of a child, heart sounds are heard in the usual place, but relatively quickly (1-2 hours) shift to the right beyond the midline or even the nipple line.

The main symptoms of a diaphragmatic hernia are a displacement of the boundaries of the heart (usually to the right) and the appearance in the lung field of cellular cavities of uneven size, corresponding to the filling of displaced intestinal loops with gas.

When examining a child in the first hours after birth, the cavities are relatively small, their number gradually increases, and they become larger.

A contrast study, which is carried out with iodo-lipol, is indicated only if the diagnosis is in doubt. For these purposes, a newborn is injected through a tube into the stomach with 5-7 ml of iodized oil (iodolipol), which, spreading, well contours the wall of the stomach.

A re-examination after 2-3 hours can show the passage of the contrast agent through the small intestine and reveal its displacement into the chest cavity.

Infringement of false diaphragmatic hernias. Due to the presence of "hard" hernial orifices in false diaphragmatic hernias, infringement of the displaced abdominal organs is possible more often than in other hernias of the abdominal obstruction. Infringement of hollow organs is characterized by a sudden onset.

The phenomena of acute obstruction of the gastrointestinal tract in combination with respiratory failure come to the fore.

An early sign that allows you to suspect infringement are bouts of cramping pain. Infants suddenly begin to worry, toss about in bed, grab their stomachs with their hands.

Authors: Drozdov A.A., Drozdova M.V.

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