Bochdalek hernia

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Obesity, Sleep & Internal medicine
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Bochdalek hernia
Synonyms	Posterolateral diaphragmatic hernia
Pronounce	N/A
Specialty	Pediatrics, Surgery
Symptoms	Respiratory distress, Cyanosis, Tachypnea
Complications	Pulmonary hypoplasia, Gastrointestinal malrotation
Onset	Neonatal
Duration
Types
Causes	Congenital defect in the diaphragm
Risks
Diagnosis	Chest X-ray, Ultrasound, MRI
Differential diagnosis	Congenital pulmonary airway malformation, Eventration of the diaphragm
Prevention
Treatment	Surgical repair
Medication
Prognosis	Variable, depends on severity and associated anomalies
Frequency	1 in 2,000 to 5,000 live births
Deaths

A Bochdalek hernia is a type of congenital diaphragmatic hernia (CDH) that occurs when there is a defect in the diaphragm, allowing abdominal organs to move into the thoracic cavity. This condition is named after the Czech anatomist Vincent Alexander Bochdalek, who first described it in the 19th century.

Anatomy and Pathophysiology

The diaphragm is a muscular structure that separates the thoracic cavity from the abdominal cavity. It plays a crucial role in respiration by contracting and relaxing to allow air into the lungs. In a Bochdalek hernia, there is a defect in the posterolateral part of the diaphragm, usually on the left side, which allows abdominal organs such as the stomach, intestines, and sometimes the spleen to herniate into the thoracic cavity. This herniation can lead to compromised lung development, known as pulmonary hypoplasia, due to the reduced space in the thoracic cavity. The severity of the condition depends on the size of the hernia and the extent of organ displacement.

Clinical Presentation

Infants with a Bochdalek hernia often present with respiratory distress shortly after birth. Symptoms may include:

• Tachypnea (rapid breathing)
• Cyanosis (bluish discoloration of the skin due to lack of oxygen)
• Tachycardia (rapid heart rate)
• Decreased breath sounds on the affected side

In some cases, the condition may be diagnosed prenatally through ultrasound imaging, which can reveal the presence of abdominal organs in the thoracic cavity.

Diagnosis

Diagnosis of a Bochdalek hernia is typically confirmed through imaging studies. A chest X-ray can show the presence of abdominal organs in the chest cavity and a shift of the mediastinum. Ultrasound and MRI may also be used to assess the extent of the hernia and the condition of the lungs.

Treatment

The primary treatment for a Bochdalek hernia is surgical repair. The timing of surgery depends on the severity of the condition and the stability of the infant. In some cases, stabilization with mechanical ventilation and other supportive measures is necessary before surgery can be performed. The surgical procedure involves repositioning the herniated organs into the abdominal cavity and repairing the defect in the diaphragm. Postoperative care is crucial to manage any respiratory complications and ensure proper recovery.

Prognosis

The prognosis for infants with a Bochdalek hernia varies depending on the size of the hernia, the degree of pulmonary hypoplasia, and the presence of any associated anomalies. Advances in neonatal care and surgical techniques have improved outcomes, but the condition can still be life-threatening in severe cases.

See also

• Congenital diaphragmatic hernia
• Diaphragm
• Pulmonary hypoplasia
• Vincent Alexander Bochdalek