Pediatric surgery. Complicated true hernia of the diaphragm itself (the most important)

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Pediatric surgery. Complicated true hernia of the diaphragm itself (the most important)

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26. Complicated true hernia of the diaphragm proper

The nature of the course of the disease depends mainly on the degree of displacement of the abdominal organs into the chest. In some cases, the hernial gates are small in size, and the hernial sac is stretched to a significant extent and filled with organs moved into the pleural cavity.

Compression of the lungs, displacement of the heart and mediastinal vessels with a significant violation of their function. The patency of the gastrointestinal tract may be impaired.

clinical picture. The acute course of a true congenital hernia of the diaphragm itself occurs in the presence of a total displacement of the abdominal organs into the chest, which is usually observed in newborns and children in the first months of life.

In older children, infringement of the displaced abdominal organs may occur in the presence of a relatively small defect in the diaphragm proper and a significant hernial sac. The clinical manifestations of these complications have some differences.

The acute course of true hernias and relaxation of the diaphragm usually manifests itself in the first days after birth as a symptom of "asphyxial infringement".

The general condition of the child progressively worsens, cyanosis increases, breathing becomes superficial, slow. The abdomen is retracted, while breathing, the epigastric region sinks. There is vomiting.

However, the listed symptoms are less pronounced than with false hernias, and are not so constant.

Infringement of true hernias of the diaphragm itself is extremely rare. This is mainly due to the absence of clearly defined ("hard") hernial orifices or their significant diameter.

With a limited diaphragm defect, infringement manifests itself with a sudden onset. The clinical picture is characterized by sharp pains in the chest and abdomen, respiratory failure and intestinal obstruction.

X-ray examination. X-ray examination allows you to clarify the diagnosis. The pictures show the movement of intestinal loops into the pleural cavity and a sharp shift of the mediastinum in the opposite direction.

A characteristic radiological sign of significant true hernias of the diaphragm itself, as well as its relaxation, is the high standing and paradoxical movement of the abdominal obstruction. With multi-axis transillumination, the diaphragm is visible in the form of a thin regular arcuate line, below which gas bubbles of the stomach and intestinal loops are located.

Differential diagnosis. Differential diagnosis should be carried out, as in the acute course of a false hernia, with some congenital heart defects, birth trauma of the brain and lobar emphysema of the lung.

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

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