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Symptomatic Diaphragmatic Hernia

  • Goran Augustin
Chapter

Abstract

A diaphragmatic hernia is a rare condition during pregnancy, but symptomatic form carries high maternal and especially fetal mortality. Nonspecific symptoms are commonly attributed to other diseases especially because clinicians are reluctant to use plain chest X-ray which is often diagnostic. Fortunately, the use of thoracic sonography and thoracic MRI adds to earlier and more accurate diagnosis. As many cases present immediately after labor, abdominal and/or thoracic CT can be performed and is also diagnostic. If the patient is symptomatic, treatment is surgical mostly at the time of presentation. A treatment algorithm is less straightforward for asymptomatic patients detected during pregnancy. Some recommend surgical treatment to prevent complications during labor when increased intra-abdominal pressure occurs, while others operate only when symptoms develop. Type of the delivery is also not solved completely. While some recommend Cesarean section with simultaneous diaphragmatic hernia repair, others claim that vaginal delivery is safe with laparoscopic diaphragmatic hernia repair at a later date.

References

  1. 1.
    Reid J. Case of diaphragmatic hernia produced by a penetrating wound. Edinb Med Surg J. 1840;53:104–12.Google Scholar
  2. 2.
    Cooper A. Phrenic hernia. In: Cooper A, editor. The anatomy and surgical treatment of abdominal hernia. London: Longman; 1827.Google Scholar
  3. 3.
    Ude WH, Rigler L. Hernia of the diaphragm through the esophageal hiatus with report of nineteen cases. Minn Med. 1929;12:751–8.Google Scholar
  4. 4.
    Naumann G. Hernia diaphragmatica, laparotomie. Dod Hygeia. 1888;50:524.Google Scholar
  5. 5.
    O’Dwyer J. Operation for relief of congenital diaphragmatic hernia. Arch Pediatr. 1889;9:130–2.Google Scholar
  6. 6.
    Heidenhain L. Geschichte eines Falles von chronischer Incarceration des Magens in einer angeborenen Zwerchfellhernie welcher durch Laparotomie geheilt wurde mit anschliessenden Bemerkungen tiber die Möglichkeit das Kardiacarcinom der Speiseröhre zu resesziren. Dtsch Z Chir. 1905;76:394–403.Google Scholar
  7. 7.
    Müller R. Ileus in der Schwangerschaft infolge eingeklemmter Zwerchfellshernie; 1913.Google Scholar
  8. 8.
    Crump W. Diaphragmatic hernia with rupture complicating a three months’ pregnancy. J Am Inst Homeopath. 1911;4:663.Google Scholar
  9. 9.
    Nava S, Zanotti E, Ambrosino N, et al. Evidence of acute diaphragmatic fatigue in a “natural” condition. The diaphragm during labor. Am Rev Respir Dis. 1992;146:1226–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Calvinho P, Bastos C, Bernardo J, et al. Diaphragmatic eventration: long-term follow-up and results of open-chest plicature. Eur J Cardiothorac Surg. 2009;36:883–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Pandey D, Garg D, Tripathi BN, et al. Dyspnea in pregnancy: an unusual cause. J Basic Clin Reprod Sci. 2014;3:68–70.CrossRefGoogle Scholar
  12. 12.
    Diddle AW, O’Connor K. Diaphragmatic hernia and pregnancy; report of a case. Obstet Gynecol. 1955;5:811–4.PubMedGoogle Scholar
  13. 13.
    Chen Y, Hou Q, Zhang Z, et al. Diaphragmatic hernia during pregnancy: a case report with a review of the literature from the past 50 years. J Obstet Gynaecol Res. 2011;37:709–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Genc MR, Clancy TE, Ferzoco SJ, et al. Maternal congenital diaphragmatic hernia complicating pregnancy. Obstet Gynecol. 2003;102:1194–6.PubMedGoogle Scholar
  15. 15.
    Kaloo PD, Studd R, Child A. Postpartum diagnosis of a maternal diaphragmatic hernia. A N Z J Obstet Gynaecol. 2001;41:461–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Barbetakis N, Efstathiou A, Vassiliadis M, et al. Bochdaleck’s hernia complicating pregnancy: case report. World J Gastroenterol. 2006;12:2469–71.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rigler LG, Eneboe J. Incidence of hiatus hernia in pregnant women and its significance. J Thorac Surg. 1935;4:262–6.Google Scholar
  18. 18.
    Eglinton TW, Coulter GN, Bagshaw PF, et al. Diaphragmatic hernias complicating pregnancy. ANZ J Surg. 2006;76:553–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Kurzel RB, Naunheim KS, Schwartz RA. Repair of symptomatic diaphragmatic hernia during pregnancy. Obstet Gynecol. 1988;71:869–71.Google Scholar
  20. 20.
    Madden MR, Paull DE, Finkelstein J, et al. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma. 1989;29:292–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Unemoto K, Sakai M, Shima H, et al. Increased expression of ICAM-1 and VCAM-1 in the lung of nitrofen-induced congenital diaphragmatic hernia in rats. Pediatr Surg Int. 2003;19:365–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Chang R, Andreoli S, Ng Y, et al. VEGF expression is downregulated in nitrofen-induced congenital diaphragmatic hernia. J Pediatr Surg. 2004;39:825–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Teramoto H, Yoneda A, Puri P. Gene expression of fibroblast growth factors 10 and 7 is downregulated in the lung of nitrofen-induced diaphragmatic hernia in rats. J Pediatr Surg. 2003;38:1021–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Dudley AS, Teaford H, Gatewood T, et al. Delayed traumatic rupture of the diaphragm in pregnancy. Obstet Gynecol. 1979;53:25S–7S.Google Scholar
  25. 25.
    Moore JB, Moore EE, Thompson J. Abdominal injuries associated with penetrating trauma in the lower chest. Am J Surg. 1980;140:724–30.CrossRefPubMedGoogle Scholar
  26. 26.
    Degiannis E, Levy RD, Sofianos C, et al. Diaphragmatic herniation after penetrating trauma. Br J Surg. 1996;83:88–91.CrossRefPubMedGoogle Scholar
  27. 27.
    Payne JH, Yellin A. Traumatic diaphragmatic hernia. Arch Surg. 1982;117:18–24.CrossRefPubMedGoogle Scholar
  28. 28.
    Boulanger BR, Milzman DP, Rosati C, et al. A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma. 1993;35:255–60.CrossRefPubMedGoogle Scholar
  29. 29.
    Chughtai T, Ali S, Sharkey P, et al. Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg. 2009;52:177–81.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Kearney PA, Rouhana SW, Burney R. Blunt rupture of the diaphragm: mechanism, diagnosis, and treatment. Ann Emerg Med. 1989;18:1326–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Rabinovici J, Czerniak A, Rabau M, et al. Diaphragmatic rupture in late pregnancy due to blunt injury. Injury. 1986;17:416–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Reed MWR, de Silva PH, Mostafa SM, et al. Diaphragmatic hernia in pregnancy. Br J Surg. 1987;74:435.CrossRefPubMedGoogle Scholar
  33. 33.
    Fardy H. Vomiting in late pregnancy due to diaphragmatic hernia: case report. BJOG. 1984;91:390–2.CrossRefGoogle Scholar
  34. 34.
    Dave KS, Bekassy SM, Wooler G, et al. “Spontaneous” rupture of the diaphragm during delivery. Br J Surg. 1973;60:666.CrossRefPubMedGoogle Scholar
  35. 35.
    Khandelwal M, Krueger C. Diaphragmatic hernia after laparoscopic esophagomyotomy for esophageal achalasia in pregnancy. ISRN Gastroenterol. 2011;2011:871958.CrossRefPubMedGoogle Scholar
  36. 36.
    Fleyfel M, Provost N, Ferreira J, et al. Management of diaphragmatic hernia during pregnancy. Anesth Analg. 1998;86:501.CrossRefPubMedGoogle Scholar
  37. 37.
    Streitz JM, Ellis FJ. Iatrogenic paraesophageal hiatus hernia. Ann Thorac Surg. 1990;50:446–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Pellegrini CA, Leichter R, Patti M, et al. Thoracoscopic esophageal myotomy in the treatment of achalasia. Ann Thorac Surg. 1993;56:680–2.CrossRefPubMedGoogle Scholar
  39. 39.
    Irwin RS, Rosen MJ, Braman S. Cough a comprehensive review. Arch Intern Med. 1977;137:1186–91.CrossRefPubMedGoogle Scholar
  40. 40.
    Kobayashi I, Kondo T, Ohta Y, et al. Expiratory activity of the inspiratory muscles during cough. Jpn J Physiol. 1992;42:905–16.CrossRefPubMedGoogle Scholar
  41. 41.
    Derbes VJ, Haran T. Rib fractures from muscular effort with particular reference to cough. Surgery. 1954;35:294–321.PubMedGoogle Scholar
  42. 42.
    Oechsli W. Rib fractures from cough: report of twelve cases. J Thorac Surg. 1936;5:530–4.Google Scholar
  43. 43.
    Ortega-Carnicer J, Ambros A, Alcazar R. Obstructive shock due to labor related diaphragmatic hernia. Crit Care Med. 1998;26:616–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Kjeldsen J. Hemodynamic investigations during labor and delivery. Acta Obstet Gynecol Scand. 1979;89:144–53.Google Scholar
  45. 45.
    Hamaji M, Burt BM, Ali SO, et al. Spontaneous diaphragm rupture associated with vaginal delivery. Gen Thorac Cardiovasc Surg. 2013;61:473–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Hamoudi D, Bouderka MA, Benissa N, et al. Diaphragmatic rupture during labor. Int J Obstet Anesth. 2004;13:284–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Hill R, Heller MB. Diaphragmatic rupture complicating labor. Ann Emerg Med. 1996;27:522–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Ross DB, Stiles G. Spontaneous rupture of the diaphragm in labour: a case report. Can J Surg. 1989;32:212–3.PubMedGoogle Scholar
  49. 49.
    Boufettal R, Lefriyekh MR, Boufettal H, et al. Spontaneous diaphragm rupture during delivery. Case report. J Gynecol Obstet Biol Reprod. 2008;37:93–6.CrossRefGoogle Scholar
  50. 50.
    Walther B, DeMeester TR, Lafontaine E, et al. Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy. Am J Surg. 1984;147:111–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Curran D, Lorenz R, Czako P. Gastric outlet obstruction at 30 weeks’ gestation. Obstet Gynecol. 1999;93:851.Google Scholar
  52. 52.
    Penman W. Hiatal hernia: a cause of persistent gastrointestinal disturbances in pregnancy. West J Surg Obstet Gynecol. 1951;59:622–5.PubMedGoogle Scholar
  53. 53.
    Lococo F, Cesario A, Meacci E, et al. Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia. Interact Cardiovasc Thorac Surg. 2012;15:317–8.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Louw JT, Louw J. Extra-genital surgical emergencies of the abdomen in pregnancy. S Afr Med J. 1954;28:788–93.Google Scholar
  55. 55.
    Vinson P. Oesophageal stricture following the vomiting of pregnancy. Surg Gynecol Obstet. 1921;33:412–3.Google Scholar
  56. 56.
    Sutherland H. Indirect traumatic rupture of the diaphragm. Postgrad Med J. 1958;34:210–1.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Kawashima K, Nakahata K, Negoro T, et al. “Spontaneous” rupture of the maternal diaphragm. Anesthesiology. 2013;118:445.CrossRefPubMedGoogle Scholar
  58. 58.
    Carter BN, Giuseffi J. Strangulated diaphragmatic hernia. Ann Surg. 1948;128:210–25.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Servais EL, Stiles BM, Finnerty BM, et al. Ruptured diaphragmatic eventration: a rare cause of acute postpartum dyspnea. Ann Thorac Surg. 2012;93:e143–4.CrossRefPubMedGoogle Scholar
  60. 60.
    Lacayo L, Taveras JM III, Sosa N, Ratzan K. Tension fecal pneumothorax in a postpartum patient. Chest. 1993;103:950–1.CrossRefPubMedGoogle Scholar
  61. 61.
    Luu TD, Reddy VS, Miller DL, et al. Gastric rupture associated with diaphragmatic hernia during pregnancy. Ann Thorac Surg. 2006;82:1908–10.CrossRefPubMedGoogle Scholar
  62. 62.
    Watkin DS, Hughes S, Thompson M. Herniation of colon through the right diaphragm complicating the puerperium. J Laparoendosc Surg. 1993;3:583.CrossRefPubMedGoogle Scholar
  63. 63.
    Morcillo-López I, Hidalgo-Mora JJ, Baamonde A, et al. Gastric and diaphragmatic rupture in early pregnancy. Interact Cardiovasc Thorac Surg. 2010;11:713–4.CrossRefPubMedGoogle Scholar
  64. 64.
    Flamée P, Pregardien C. Tension gastrothorax causing cardiac arrest. Can Med Assoc J. 2012;184:E82.CrossRefGoogle Scholar
  65. 65.
    Osborne WW, Foster C. Diaphragmatic hernia complicating pregnancy. Am J Obstet Gynecol. 1953;66:682–4.CrossRefPubMedGoogle Scholar
  66. 66.
    Gibson F. Diagnosis of diaphragmatic hernia with acute obstruction. JAMA. 1929;93:1719–24.CrossRefGoogle Scholar
  67. 67.
    Indarl A, Bornman PC, Beckingham I. Late presentation of traumatic diaphragmatic hernia in pregnancy. Ann R Coll Surg Engl. 2001;83:392–3.Google Scholar
  68. 68.
    Savage P. Obstructed volvulus of the stomach in a diaphragmatic hernia: a post-partum emergency. Proc R Soc Med. 1968;61:956–7.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Wolfe CA, Peterson M. An unusual cause of massive pleural effusion in pregnancy. Thorax. 1988;43:484–5.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Satin AJ, Twickler DGLI. Esophageal achalasia in late pregnancy. Obstet Gynecol. 1992;79:812–4.PubMedGoogle Scholar
  71. 71.
    Mitchell TE, Ridley PD, Forrester-Wood C. Spontaneous rupture of a congenital diaphragmatic eventration. Eur J Cardiothorac Surg. 1994;8:281–2.CrossRefPubMedGoogle Scholar
  72. 72.
    Gorbach JS, Counselman FL, Mendelson M. Spontaneous pneumomediastinum secondary to hyperemesis gravidarum. J Emerg Med. 1997;15:639–43.CrossRefPubMedGoogle Scholar
  73. 73.
    Woolford TJ, Birzgalis AR, Lundell C, et al. Vomiting in pregnancy resulting in oesophageal perforation in a 15-year-old. J Laryngol Otol. 1993;107:1059–60.PubMedGoogle Scholar
  74. 74.
    Dresner SM, Bailey JL, Lamb P, et al. Spontaneous oesophageal perforation during vaginal delivery. J R Soc Med. 2001;94:90–1.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Troop B, Myers RM, Agarwal N, et al. Early recognition of diaphragmatic injuries from blunt trauma. Ann Emerg Med. 1985;14:97–101.CrossRefPubMedGoogle Scholar
  76. 76.
    Julien F, Drolet S, Lévesque I, et al. The right lateral position for laparoscopic diaphragmatic hernia repair in pregnancy: technique and review of the literature. J Laparoendosc Adv Surg Tech A. 2011;21:67–70.CrossRefPubMedGoogle Scholar
  77. 77.
    Eren S, Ceviz N, Alper F. Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review. Eur J Radiol. 2004;51:85–90.CrossRefPubMedGoogle Scholar
  78. 78.
    Rubin S, Sandu S, Durand E, et al. Diaphragmatic rupture during labour, two years after an intra-oesophageal rupture of a bronchogenic cyst treated by an omental wrapping. Interact Cardiovasc Thorac Surg. 2009;9:374–6.CrossRefPubMedGoogle Scholar
  79. 79.
    Hernández-Aragon M, Rodriguez-Lazaro L, Crespo-Esteras R, et al. Bochdalek diaphragmatic hernia complicating pregnancy in the third trimester: case report. Obstet Gynecol Cases Rev. 2015;2.Google Scholar
  80. 80.
    Sharma R, Rosha D, Dash SK, et al. Tension gastrothorax complicating third trimester of pregnancy: suspicion is the key. J Clin Imaging Sci. 2012;2:49.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Henzler M, Martin ML, Young J. Delayed diagnosis of traumatic diaphragmatic hernia during pregnancy. Ann Emerg Med. 1988;17:350–3.CrossRefPubMedGoogle Scholar
  82. 82.
    Zieren J, Enzweiler C, Muller J. Tube thoracostomy complicates unrecognized diaphragmatic rupture. Thorac Cardiovasc Surg. 1999;47:199–202.CrossRefPubMedGoogle Scholar
  83. 83.
    Myers BF, McCabe C. Traumatic diaphragmatic hernia: occult marker of serious injury. Ann Surg. 1993;218:783–90.CrossRefGoogle Scholar
  84. 84.
    Aydin Y, Altuntas B, Ulas A, et al. Morgagni hernia: transabdominal or transthoracic approach? Acta Chir Belg. 2014;114:131–5.PubMedGoogle Scholar
  85. 85.
    Thomas V. A rare case of Morgagni diaphragmatic hernia presenting in pregnancy. Indian J Surg. 2012;74:348–50.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Campos LI, Sipes E. Laparoscopic repair of diaphragmatic hernia. J Laparoendosc Surg. 1991;1:369–73.CrossRefPubMedGoogle Scholar
  87. 87.
    Palanivelu C, Rangarajan M, Rajapandian S, et al. Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study. Surg Endosc. 2009;23:978–85.CrossRefPubMedGoogle Scholar
  88. 88.
    Brusciano L, Izzo G, Maffettone V, et al. Laparoscopic treatment of Bochdalek hernia without the use of a mesh. Surg Endosc. 2003;17:1497–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Wieman E, Pollock G, Moore BT, et al. Symptomatic right-sided diaphragmatic hernia in the third trimester of pregnancy. JSLS. 2013;17:358–60.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Debergh I, Fierens K. Laparoscopic repair of a Bochdalek hernia with incarcerated bowel during pregnancy: report of a case. Surg Today. 2014;44:753–6.CrossRefPubMedGoogle Scholar
  91. 91.
    Rolton DJ, Lovegrove RE, Dehn TC. Laparoscopic splenectomy and diaphragmatic rupture repair in a 27-week pregnant trauma patient. Surg Laparosc Endosc Percutan Tech. 2009;19:e159–60.CrossRefGoogle Scholar
  92. 92.
    Palanivelu C, Rangarajan M, Maheshkumaar GS, et al. Laparoscopic mesh repair of a Bochdalek diaphragmatic hernia with acute gastric volvulus in a pregnant patient. Singap Med J. 2008;49:e26–8.Google Scholar
  93. 93.
    Šenkyrik M, Lata J, Husová L, et al. Unusual Bochdalek hernia in puerperium. Hepato-Gastroenterology. 2003;50:1449–51.PubMedGoogle Scholar
  94. 94.
    Olaru AI, Uzochukwu I, Sheehan K, et al. Bochdalek diaphragmatic hernia rupture in pregnancy: a case report. Ann Clin Cas Rep. 2017; 2:1275.Google Scholar
  95. 95.
    Sano A, Kato H, Hamatani H, et al. Diaphragmatic hernia with ischemic bowel obstruction in pregnancy: report of a case. Surg Today. 2008;38:836–40.CrossRefPubMedGoogle Scholar
  96. 96.
    Stringer RA, Salameh J. Mesh herniorrhaphy during elective colorectal surgery. Hernia. 2005;9:26–8.CrossRefPubMedGoogle Scholar
  97. 97.
    Kelly ME, Behrman S. The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg. 2002;68:524–8.Google Scholar
  98. 98.
    Kushlan S. Diaphragmatic hernia in pregnancy: significance and danger. Conn State Med J. 1951;15:969–78.Google Scholar
  99. 99.
    Dumont M. Hernie diaphragmatique et grossesse. Gynecol Obstet Biol Reprod. 1990;19:395–9.Google Scholar
  100. 100.
    Moss RL, Chen CM, Harrison M. Prosthetic patch durability in congenital diaphragmatic hernia: a long-term follow-up study. J Pediatr Surg. 2001;36:152–4.CrossRefPubMedGoogle Scholar
  101. 101.
    Craddocck DR, Hall J. Strangulated diaphragmatic hernia complicating pregnancy. Br J Surg. 1968;55:559–60.CrossRefGoogle Scholar

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Authors and Affiliations

  • Goran Augustin
    • 1
    • 2
  1. 1.School of Medicine University of ZagrebZagrebCroatia
  2. 2.Department of SurgeryUniversity Hospital Centre ZagrebZagrebCroatia

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