Diaphragmatic hernia in the fetus
Author: doctor Deryushev A.N.
A diaphragmatic hernia is the movement of the abdominal organs into the chest cavity, through a defect in the diaphragm, or when there is a weak zone in it. In this case, the presence of a hernial sac, hernial ring, and hernial contents is characteristic. Moreover, if the hernial sac is absent - the hernia is called false.
All diaphragmatic hernias are divided into traumatic and non-traumatic. Non-traumatic hernias, to which the diaphragmatic hernia of the fetus belongs, are divided into false congenital hernias (defects) of the diaphragm, true hernias of the weak areas of the diaphragm, true hernias of atypical localizations, hernias of the natural orifices of the diaphragm.
Diaphragmatic hernia in the fetus occurs as a result of malformations of the diaphragm. Congenital hernias are divided into true hernias, which have a hernial sac and false, in which the abdominal organs through a through defect in the diaphragm are in direct contact with the lungs and heart. The frequency of occurrence of such hernias according to statistical data is 1 case per 1700 newborns. Quite often, hernia of the diaphragm is combined with other malformations (congenital dislocation of the hip, pyloric stenosis, heart defects). Such combined defects account for 6-8%.
The hernia of the esophageal orifice of the diaphragm in the fetus develops due to the slowing down of the rate of lowering of the stomach from the chest cavity into the abdominal cavity and the absence of obstruction of the air-intestinal pockets, as a result of which the hernial sacs are formed.
Congenital hernias of the diaphragm, including those with its slit-like defects, occur in anatomically “weak” parts of the diaphragm - this is the sterno-costal gap, lumbar triangle, etc. The formation of thinned areas or even through defects of the diaphragm occurs at very early stages of embryo and fetus development. Violation of trophic processes in the muscle tab of the diaphragm, leads to a slow pace of its development, and increased intra-abdominal pressure compared to intrapleural pressure leads to the movement of the abdominal organs into the chest cavity and this happens in the last weeks of intrauterine life.
In newborns with a slit-like defect in the posterior part of the diaphragm, cyanosis of the skin, vomiting, and displacement of the heart are observed. Crucial importance in the diagnosis of such conditions are radiographic methods of examination of the chest. Treatment, as a rule, is operative, and in case of asphyxial pinching of the hernia in a newborn, such operations are carried out urgently, as is also important when the diaphragm is ruptured.
In the process of such an operation, in newborns, with a small volume of the abdominal cavity that does not accommodate organs, retracted from the pleural cavity, the first stage of the operation creates an artificial ventral hernia, which is then eliminated by the second stage from 6 days to 12 months after the first operation. Also carried out the drainage of the pleural cavity. Unfortunately, according to statistics, 50% of operated children have postoperative complications. There are common complications (such as fever, depression of the respiratory center, impaired water-salt metabolism), pulmonary complications (pleurisy, pneumonia, edema), abdominal complications (various types of intestinal obstruction), as well as an excessive increase in intraperitoneal pressure. which is accompanied by restriction of movements of the diaphragm and compression of the inferior vena cava.
With hernias located near the esophagus - the so-called paraesophageal hernias most often relapse after surgery. To avoid this, after a period of breastfeeding, in addition to the appointments of the attending physician, you should follow a diaphragmatic hernia diet prescribed by a nutritionist.
Even with the condition of timely operation in newborns with diaphragmatic hernia, the mortality rate is up to 10 -12%.
Author: doctor Deryushev A.N.
The diet recommended for diaphragmatic hernias is not just some advice on the use of certain products, but rather a set of measures that occupies an important place in the general plan of treatment of this disease. As with many diseases of the gastrointestinal tract, with diaphragmatic hernia more frequent food intake is recommended, but the volume of servings is reduced.
author: doctor Obukhova Yu.A.
The intervertebral Schmorl's hernia is a structural formation of the spine, manifested as a depression of the intervertebral disc in the vertebral body.
author: doctor Ainullin A.A.
Schmorl's hernia is a disease of the spine, in which the intervertebral disc is pressed into the body of the higher or lower vertebra. This is due to the thinning of the bone plate, separating the vertebral body from the intervertebral disc. Most often, the lumbar spine is affected, since it accounts for the main load, however, Schmorl's hernia can appear in any part of the spine if there are predisposing factors.
author: doctor Filonenko A.I.
Very often the draftee and his parents are interested in the question: "Are they taking into the army with Schmorl's hernia?" Let's first understand what the disease is and what symptoms accompany it. When Schmorl hernia from the intervertebral disc into the body of the vertebra is indented cartilage. This disease may be one of the syndromes of Scheuermann's disease - Mau. In addition, Schmorl's hernia often appears in kyphosis - a strong stoop.
author: doctor Krivega MS
Not everyone easily gets kids, some parents and their kids pay for the happiness of being together too expensive, getting health problems. Unfortunately, not all of them can be warned. Hematoma that occurs at birth, refers to such diseases.
Predispose to the appearance of hematoma such factors: