The first mention of "diaphragmatic hernia" refers to the 16th century. It belongs to the famous doctor of that time - Ambroise Paré. This term should be understood as the penetration of certain internal organs through defects in the diaphragm.
You should be aware that for some disorders that occur during complications in the embryonic development of the fetus, partial or complete diaphragm defects in newborns can occur. In the case when these violations occur until the diaphragm is formed, the hernia will not have a hernial sac. In case of developmental abnormalities that have occurred after the formation of the diaphragm membrane, the hernial sac consisting of serous films penetrates through the hernial gates that do not contain muscles.
The area of connection of the costal part with the sternum, which is devoid of muscles, is the site of the sterno-costal hernia. Otherwise, they are called sternocostal hernias. This vulnerability is called the sternocostal triangle of Larrey, and the hernias that arise there are also called the hernias of the Larrey triangle.
Diaphragmatic hernia can be caused by various reasons. Suppose this disease was classified by B.V. Petrovsky, thus:
1. hernia resulting from injuries (traumatic hernia):
- false;
- true.
2. non-traumatic hernia:
- congenital false;
- true hernia of the weak zone of the diaphragm;
- diaphragmatic hernia of natural holes:
- true hernia of atypical localization;
3. hiatal hernia ;
4. rare hernia of natural openings.
If a diaphragmatic hernia, the symptoms of which are directly related to injuries or injuries, is divided only into false and true, then non-traumatic hernias have a broader classification. The only false is a congenital hernia, which occurs due to defects in the diaphragm (non-closure of the abdominal and chest cavities).
The true hernias of weak zones of the diaphragm include hernias of the sterno-rib triangle. In this area, the chest is separated from the peritoneum with a thin plate of connective tissue located between the peritoneum and pleura.
Retrostenal hernias are characteristic of an underdeveloped area of the sternum of the diaphragm.
Extremely rare hernias of the vena cava, crevices of the sympathetic nerve and aorta. The most common variety (about 98% of all cases) is diaphragmatic hiatal hernia.
It has its own anatomical features. There are several types of this disease. Such hernias include: sliding, with a change in the esophagus (with shortening, without shortening); cardiac; subtotal; cardiofundal; total.
Existing paraesophageal hernias are divided into: intestinal, omental, fundic, gastrointestinal.
Specialists distinguish between:
1. congenital "shortened esophagus";
2. paraesophageal hernia, in which part of the stomach is located on the side of the usually located esophagus;
3. a sliding hernia of the esophagus , in which the esophagus with the cardiac zone of the stomach can be drawn into the chest cavity.
Paraesophageal hernia, like sliding hernia, can be congenital and acquired, but congenital hernias are rarer than acquired. In people over the age of 40, acquired hernias are more often observed. Of great importance is the age-related involution of tissues, leading to the expansion of the esophagus and weakening of the connections of the diaphragm and esophagus.
Most often, two factors become the cause of hernia. One of them is the pulsation factor, in which a hernia is formed due to an increase in intra-abdominal pressure (heavy physical exertion, flatulence, overeating, pregnancy, constant wearing of tight belts). Another factor is traction, associated with hypermotorism of the esophagus caused by frequent vomiting.
A decisive role in determining the diagnosis is played by x-ray examination. Diaphragmatic hernias are divided by diameter into small (up to 3 cm), medium (from 3 to 8 cm) and large (more than 8 cm).
Diaphragmatic hernia, the treatment of which by conservative methods may not bring the desired result, is best treated with surgical methods.