pediatrics
Diaphragmatic Hernia
Symptoms and Signs of Diaphragmatic Hernia
Respiratory distress typically occurs in the first several hours after birth and occurs immediately after delivery in severe cases. After delivery, as the neonate cries and swallows air, the stomach and the loops of intestine quickly fill with air and rapidly enlarge, causing acute respiratory compromise as the heart and mediastinal structures are pushed to the right (with the most frequent left-sided hernia), compressing the more normal right lung. A scaphoid abdomen (due to displacement of abdominal viscera into the chest) is likely. Bowel sounds (and an absence of breath sounds) may be heard over the involved hemithorax. In less severe cases, mild respiratory difficulty develops a few hours or days later as abdominal contents progressively herniate through a smaller diaphragmatic defect. Rarely, presentation is delayed until later in childhood, sometimes after a bout of infectious enteritis, which causes sudden herniation of bowel into the chest. 