Diaphragmatic hernia in children, as in adults, is a defect in the anatomical septum that separates the chest from organs located in the abdominal cavity. The disease is chronic and may be accompanied by a displacement or protrusion of organs.
This disease is diagnosed by x-ray examination. This happens, as a rule, with complaints of pain in the chest or abdomen. This disease can occur without any symptoms, in which case it remains undiagnosed.
What is a diaphragm?
The diaphragm is a septum that divides the chest and abdominal regions in the human body. On the sides, this septum is represented by striated muscles, and in its central part by fibrous tissue.
The diaphragm itself is an unpaired domed muscle. Schematically, that is, conditionally, its location can be drawn along the bottom line of the ribs. The presence of this organ is unique to mammals, the only exception being crocodiles. They also have a diaphragm, although less developed, in comparison with mammals.
The domed structure of this organ repeats the bottom line of the ribs. The upper plane of the diaphragm is the bottom, the lower boundary for the chest area. And the lower one, respectively, serves as the upper limit for the abdominal cavity.
The dome is formed by the convergence of the muscles forming the crest of the organ, which is the central tendon. With its damage or insufficiency of tissue, both congenital and acquired, a diaphragmatic hernia occurs in children.
What is the diaphragm for?
The diaphragm is an important organ that has a number of functions that can be attributed to two groups - static and dynamic.
The supporting function belongs to the static group, which consists in ensuring the normal location and functioning of organs in both the chest and abdominal cavities. In violation of the muscle tone of the anatomical septum or its defect, an organ displacement occurs. Most often, the abdominal organs are displaced into the chest area. This phenomenon is accompanied by diaphragmatic hernia in children, the clinical recommendations for the treatment of which directly depend on the severity of the displacement and the degree of disturbance in the structure and density of the septum.
The dynamic group includes three important functions:
- respiratory, diaphragmatic muscle movements are involved in the process of ventilation in the lungs;
- cardiovascular, contraction of muscle tissue contributes to the outflow of blood and lymph from organs in the abdominal cavity and the influx in the chest area;
- motor-digestive, the septum serves as a pulp to promote food in the stomach.
Accordingly, congenital diaphragmatic hernias in children, as well as acquired ones, disrupt all these processes, causing a malfunction of the internal organs and pain or discomfort.
Why does a hernia appear?
Without exception, all varieties of this pathogenesis, including diaphragmatic hernia in children, develop due to violations, malfunctions in the process of intra-abdominal pressure and the function of counteracting it.
The main reasons why this happens are:
- genetic and congenital anatomical abnormalities in the development of an organ;
- special conditions in which there is a process of prolonged high intra-abdominal pressure, for example, long bouts of coughing or crying;
- bumps, blunt injuries, other mechanical damage;
- disturbances in the innervation of a separate area inside the diaphragm, which becomes a source of its dysfunction and leads to protrusion, while, as a rule, a hernial sac is formed;
- chronic diseases and pathologies localized in the abdominal cavity.
Other reasons for the formation of a hernia are possible, but, as a rule, it arises due to one of the above factors.
What can be a hernia?
In addition to anatomical, congenital, there are other diaphragmatic hernias in children. Pediatric surgery distinguishes the following types:
- acquired or traumatic, which, in turn, are false and true;
- neuropathic;
- hernias arising in the natural openings of the anatomical septum.
Acquired false pathological formations differ from the true ones by the presence of a hernial sac. True ones have it, false ones don’t.
How is a hernia manifested?
Diaphragmatic hernia in babies can manifest itself in the form of such symptoms:
- belching with air, present constantly;
- bloating;
- heartburn with concomitant bad breath;
- pain in the sternum and abdominal cavity;
- anemia - occurs in certain circumstances.
A symptom such as anemia appears with minor internal bleeding in the esophagus affected by a hernia.
How is a hernia diagnosed?
Symptoms are the basis for the diagnosis of diaphragmatic hernia. And treatment in children begins after confirmation of the preliminary diagnosis using the following procedures:
- X-ray examination using a barium mixture;
- FEGDS, that is, fiboroesophagogastroduodenoscopy;
- pH meter
An x-ray barium mixture is needed to give contrast. With the help of barium staining, protrusion or displacement of organs and other anatomical anomalies are clearly visible.
Diaphragmatic hernia in newborns with the help of the FEGDS procedure is not diagnosed, since this study involves the introduction of a telescopic tube for direct examination from the inside.
A pH meter test is a measure of the level of acidity in the esophagus and stomach. Diaphragmatic hernia is accompanied by an increase in the level of acidity, which causes a symptom such as heartburn.
How is hernia treated?
The method of treatment of this pathology directly depends on such factors:
- a variety of hernia and features of pathogenesis;
- age of the patient.
The therapy itself can be both operational, that is, surgical, and conservative.
About conservative treatment
Conservative treatment is carried out in the absence of the need for surgical intervention or its impossibility. Such therapy involves a special dietary diet and medication.
Of the drugs used antacids:
- "Phosphalugel";
- Almagel;
- "Ranitidine";
- Omez.
Drugs are required to normalize acidity and eliminate a symptom such as heartburn. Painful spasms are relieved by the drugs Drotaverin and No-shpa.
About surgical treatment
Surgery is performed in the following cases:
- significant dimensions of the pathological anomaly;
- infringement of internal organs;
- severe protrusion or displacement.
The operation consists in excision and removal of the hernial sac, plastic or anatomical restoration of muscle and connective fibers. In some cases, implantation of synthetic tissue can also be carried out, that is, the installation of a kind of “patch” on the hernial opening in the diaphragm.
How is certain hernia treated?
Congenital anatomical malformations and abnormalities of the development of the diaphragm are treated operatively. Surgical intervention is carried out immediately after the baby is born or a little later. The timing of the surgical operation is determined by doctors individually and depends on the characteristics of the pathology.
Acquired true hernia, resulting from a long exposure to the diaphragm of high internal abdominal pressure, is treated both conservatively and surgically. Doctors resort to conservative treatment with a small amount of pathology and no need for surgery. In the event that the size of the pathology is large and its presence threatens the functionality of the internal organs, surgery is performed.
Acquired false hernia is often accompanied by internal bleeding. As a rule, such a diaphragmatic hernia in children occurs due to a strong blow to the abdomen or another variant of mechanical damage to the organ. Therapy consists only in surgical intervention, restoring the anatomical arrangement of organs, eliminating bleeding and suturing perforation in the diaphragm. This type of damage requires a long recovery of the patient's body in stationary conditions.
Neuropathic hernial changes are the result of disturbances in the innervation of individual sections of the diaphragm. They are treated both conservatively and surgically. The technique is selected individually by the doctor. The doctor’s decision is influenced by such nuances as the size of the hernia, the presence of pathological changes or complications, and the age of the patient.
Hernias occurring in the natural openings of the anatomical septum are also treated in both ways. Surgery for such a diagnosis is resorted to in case of emergency.
The diaphragm of a child, especially a newborn, is many times weaker than an adult. Accordingly, the chance that with prolonged intra-abdominal high pressure the baby will develop a hernia in the diaphragm is extremely high. Therefore, it is extremely important not to allow a long cry, injury or other factors contributing to the formation of pathology in the anatomical septum.