Bohdalek hernia is a serious diaphragm pathology. Most often, it is congenital in nature. Approximately 1 in 3,000 babies are born with this disease. In medicine, a hernia is called a protrusion of internal organs through an opening. In the diaphragm, hernial pathologies occur quite often. Here are the organs of the abdominal cavity, such as the intestines, stomach, spleen, omentum. Their entry into the hernial opening is accompanied by impaired breathing and cardiac activity.
Diaphragm anatomy
The diaphragm is a muscle that separates the chest from the abdominal cavity. This part of the muscles is actively involved in breathing. In addition, the diaphragm is able to regulate intra-abdominal pressure.
In the region of the kidneys are lumbar-rib triangles, which are very prone to hernial abnormalities. One of them is called the Bohdalek triangle. It is in this zone that the diaphragmatic hernia of Bohdalek is localized.
The development of the diaphragm begins at 3 weeks of fetal development, and ends by 8-10 weeks. During this period, abdominal organs also form. If there is a violation of the fusion of the pleura and diaphragm, then parts of the intestine, stomach or spleen can get into the formed space. Thus, Bohdalek's hernia is formed most often in the prenatal period from 3 to 10 weeks of embryo development.
In most cases, a hernia appears on the left side. This is due to the fact that the liver prevents organs from entering the hole. Right-sided hernias are noted in about 20% of cases. In addition, above the left kidney in the diaphragm is a hole of Bohdalek, through which a hernia often goes out. Pathology is much more common in boys than in girls.
Hernia reasons
Since Bohdalek's hernia is most often congenital in nature, the cause of the pathology is the various adverse effects that a pregnant woman undergoes. The following factors can provoke such a deviation in the unborn child:
- first trimester pregnancy toxicosis;
- drinking and smoking in the early stages of gestation;
- chronic respiratory diseases in the expectant mother;
- weight lifting during pregnancy;
- use of drugs by a pregnant woman.
A difficult birth can lead to a hernia in an infant. Pathology is often noted when an excessively large child is born, especially if he passed through the narrow birth canal.
Bohdalek hernia in adults most often occurs after injuries (fall or injury). Also, gastrointestinal and respiratory diseases, obesity can lead to the development of pathology. Diaphragmatic hernias are more often formed in people older than 50 years due to age-related changes.
Symptomatology
If the disease is noted in infancy, the main symptom of the pathology is breathing and heart failure, as the hernia presses on the mediastinum. The following manifestations are noted:
- weak breathing
- right displacement of the heart beat and heart rate;
- retracted scaphoid abdomen.
In this case, the newborn does not have abdominal pain. Symptoms are mild. However, a hernia is a great threat to the life of the child. Without treatment, the baby may die from respiratory and cardiac disorders.
In adults, gastrointestinal symptoms predominate. The patient complains of the following manifestations:
- heartburn;
- burning pain in the chest and abdomen;
- vomiting after eating;
- difficulty breathing after eating;
- burping.
When listening to a patient with a phonendoscope, you can hear a splash. In the future, the patient progresses respiratory and cardiac disturbances due to compression of the hernia organs.
Diagnostics
A pediatrician is involved in the diagnosis of such a hernia in children. Adults should consult a thoracoabdominal surgeon. This specialist deals with diaphragm pathologies. The following studies are prescribed:
- computed tomography (CT);
- roentgenography;
- MRI
- Ultrasound
CT scan of Bohdalek is clearly defined in the following cases:
- With prolapse of the stomach. This pathology leads to accumulation of fluid in the left side of the chest cavity.
- With prolapse of the small intestine. Dark or light areas against the background of the lungs are determined.
- With displacement of the spleen or liver. Blackout is detected against the background of the lung.
Computed tomography allows you to determine the size and location of the hernial foramen, as well as the structure of the prolapsed internal organs.
CT scan of Bohdalek in adults looks like a large formation with a low density, with clear contours. In newborns, a heart displacement to the right is noted.
Treatment and prognosis
Bohdalek's hernia can only be cured by surgery. Conservative therapy in this case is ineffective.
In a hospital, an operation is performed. The hernial sac is opened. If the infringed organs have not undergone necrotic changes, then they are corrected. If there is tissue necrosis, then a resection of the affected areas is performed. Then the hernial opening is closed with its own tissues or a special mesh and the wound is sutured.
After surgery, adult patients are advised to avoid physical exertion, especially weight lifting. It is necessary to follow a sparing diet and not eat food that irritates the stomach and intestines. After eating, do not squat or lie down. If the patient is overweight, then weight loss is recommended.
Mortality of children with a hernia of Bohdalek reaches 30-50%. Therefore, surgery is necessary. Surgical intervention helps to save the life of the baby and improve the quality of life of an adult.
Prevention
How to prevent diaphragmatic hernia? This pathology is most often formed in the prenatal period. Therefore, a pregnant woman must avoid weight lifting, drinking alcohol, taking medications, and smoking. If the size of the fetus and the birth canal do not match, a caesarean section should be performed. If a pregnant woman has signs of early toxicosis, then it is necessary to consult a gynecologist and undergo treatment.
Adults need to avoid injuring the costal lumbar region and treat the digestive and respiratory diseases in a timely manner. It is also important to monitor your weight, as obesity is one of the causes of hernia in adulthood. If you experience symptoms such as nausea and difficulty breathing after eating, you need to contact a specialist and undergo a diagnosis.