Diaphragmatic hernia

Original Editor - Blanca Fernandez Burgos

Top Contributors - Lucinda hampton and Blanca Fernandez Burgos  

Introduction

Diaphragmatic hernias can be congenital or acquired flaws in the diaphragm.

1. Acquired (normally occur in adults):

1. Traumatic diaphragmatic rupture through either penetrating injury (65%) or blunt trauma (35%)
2. Hiatus hernia
3. Iatrogenic

2. Congenital Diaphragmatic Hernia (CDH) two main types, uncommon yet distinct forms, 80% occur on the left side of the diaphragm:

1. Bochdalek hernia: comprise 95% of CDH, located posterolaterally and usually present in infancy. Occur because of a defect in the posterior attachment of the diaphragm caused by failure of pleuroperitoneal membrane closure in utero.
2. Morgagni hernia: smaller, anterior and presenting later in life, through the sternocostal angles.

Treatment

The treatment for diaphragmatic hernias is surgical. The aim of the intervention is to replace the abdominal organs into the original position and eventually repair the damaged diaphragm. Traditionally, the surgery is done by laparotomy or thoracotomy. For CDH, the infant can need breathing support for the recovery period, for example with a lung bypass machine that support the oxygen delivery to the body. The prognosis of CDH surgical treatment depends on the level of development of the lungs and on the grade of the damage.

Physiotherapy

There is not literature that specifically addresses the physiotherapy management of diaphragmatic hernia. However, we know that surgeries such as laparatomy and thoracotomy can affect lung function, causing manifestations such as lung volume reduction, reduction in functional residual capacity, slowing of mucociliary clearance, and abnormalities in gaseous exchange Therefore the physiotherapist can put in place active respiratory techniques and prescribe these exercises according to the assessment and patient's health state. The main techniques of this area of intervention are incentive spirometry, active cycle of breathing, and thoracic expansion exercises.