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Diaphragmatic hernias (alternative plural: herniae) are defined as either congenital or acquired defects in the diaphragm.
Demographics and etiology
There are two main types of congenital diaphragmatic hernia (CDH)s which are uncommon yet distinct entities that usually occur on the left side (80%) of the diaphragm 1,2:
- Bochdalek hernia: most common (95%), located posterolaterally and usually present in infancy 2
- Morgagni hernia: smaller, anterior and presents later in life, through the sternocostal angles 2
There are a variety of etiologies for acquired diaphragmatic hernias that usually occur in adulthood 1:
- traumatic diaphragmatic rupture through either penetrating injury (65%) or blunt trauma (35%) 3
- hiatus hernia
Depending on the location and size of the defect retroperitoneal or intra-abdominal organs and tissues can prolapse into thoracic cavity due to the negative intrathoracic pressure 1. However, the converse i.e. thoracic organ herniation into the abdominal cavity is very rare.
- 1. Mullins ME, Stein J, Saini SS et-al. Prevalence of incidental Bochdalek's hernia in a large adult population. AJR Am J Roentgenol. 2001;177 (2): 363-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Deprest J, Brady P, Nicolaides K et-al. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Seminars in fetal & neonatal medicine. 19 (6): 338-48. doi:10.1016/j.siny.2014.09.006 - Pubmed
- 3. Kaiser JR, Rosenfeld CR. A population-based study of congenital diaphragmatic hernia: impact of associated anomalies and preoperative blood gases on survival. Journal of pediatric surgery. 34 (8): 1196-202. Pubmed