1919
Arise during embryological development from improper fusion of the posteriolateral foramina of the diaphragm.
More common on the left side.
Usually diagnosed in the pediatric age group.
Observed primarily in male patients.
Male:female 3:2.
Male predominance for the less common right sided is higher at 3:1.
Chest x-rays have a sensitivity for diagnosing this process of 74% (Swain).
CT of the thorax is gold standard for confirming a diagnosis.
Most common congenital diaphragmatic hernia and accounts for 95% of cases.
Signs and symptoms reflect size and content of lesion with dyspnea, chest and abdominal pain.
Organs that may be in the thoracic cavity include the ascending colon, small intestine, transverse colon, left lobe of the liver and stomach.
The stomach is involved in 40% of cases.
Patients at high risk for intestinal obstruction, gastric volvulus, and vascular compromise of herniated organs.
All cases should be surgically corrected, even if symptomatic.
Surgical approach can be abdominal, thoracic or a combination.
The chest approach is utilized when the liver is involved or the hernia sac adheres to other structures.
Small defects can be corrected with no absorbable sutures wile large defects of greater than 5 cm mesh is employed to provide a tension free repair.
Can undergo laparoscopic repair.