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06-08-2008, 08:28 AM
Types:
1) Congenital Diaphragmatic Hernia:
Ä Aetiology: A rare condition dueto persistence of the pleuroperitoneal hiatus (a communication between the pleura and peritoneum which normally closes before birth). The unclosed hiatus is called the foramen of Bochdaleck.
Ä Diagnosis: Cyanosis in the newly borne associated with air hunger. As the condition usually occurs on the left side between the dorsal and central parts of the diaphragm, the heart and mediastinum are shifted to the right. This can be detected by ausculatation and radiography.
ÄTreatment: Surgical reduction of the abdominal contents and closure of the defect, must be performed as early as possible.
Hernia through the foramen of Morgagni between the two costal origins of the diaphragm is an extremely rare condition. It gives rise to abdominal colic and vomiting. Radiography shows intestine passing behind xiphoid process.
2) Acquired Diaphragmatic Hernia:
A) Traumatic diaphragmatic Hernia:
Hernia may follow injuries of the diaphragm immediately or it may occur many years after the original trauma. The hernia leads to cardio­-respiratory embarrassment, abdominal pain and vomiting. The mediastinum may be shifted to the other side and rarely the intestine strangulates in the chest. Traumatic hernia is common on the left side as the liver supports the right side of the diaphragm.
Ä Treatment: Thoracotomy is performed to reduce the bowel and repair the defect in the diaphragm. Large defects may be repaired with strips of fascia lata.
B) Hiatus Hernia. See Oesophagus

FN.B. The traumatic diaphragmatic hernia is common in the Lt. side as the liver support the Rt. Side.


SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt

InowlVorenare
09-17-2010, 02:33 PM
F/91

paraumbilical pain for 1 week
increase pain
poor bowel habit
abdominal distension

exam..
abdomen soft

Hb 12
OGD....sliding hiatus hernia
noted from 33-40 cm from incisor

Look at CXR.