Diaphragmatic hernia refers to the protrusion of abdominal organs into the thoracic cavity through weak openings, defects, or traumatic ruptures in the diaphragm. Clinically, it is classified into three main types: hiatal hernia, congenital diaphragmatic hernia, and traumatic diaphragmatic hernia.

bubble_chart Pathogenesis

Traumatic diaphragmatic hernia can result from direct injury (such as stab wounds, gunshot wounds, or post-surgical trauma to the diaphragm) or indirect violence (like blast injuries, crush injuries, or falls) or sudden changes in thoracic or abdominal pressure (spontaneous), leading to diaphragm rupture. Generally, the hernia occurs at the time of injury or shortly thereafter. However, in some cases, the diaphragmatic tear may be temporarily occluded by the greater omentum, and the hernia only forms when factors such as increased abdominal pressure arise. It is more common on the left side, with the stomach and small intestine being the most frequently herniated contents.

bubble_chart Clinical Manifestations

In addition to the general manifestations of thoracoabdominal trauma, traumatic diaphragmatic hernia primarily presents with the following two aspects:

1. Respiratory and circulatory impairment. The severity depends on the amount of gastrointestinal organs herniated into the thoracic cavity, the degree of distension, or associated injuries. Severe cases may present with cyanosis and hypotension, even life-threatening conditions.

2. The presence or absence of gastrointestinal obstruction or rupture. For instance, if the herniated gastrointestinal tract becomes twisted, leading to obstruction or rupture, the patient may experience severe chest and abdominal pain as well as vomiting. Strangulated intestinal necrosis can result in massive hematemesis, while gastrointestinal rupture may manifest as symptoms of pleuritis.

The diagnosis can be made based on clinical manifestations, physical examination, and X-ray findings consistent with "congenital diaphragmatic defect." The physical examination and X-ray findings are the same as those for "congenital diaphragmatic defect."

bubble_chart Treatment Measures

Once the diagnosis is confirmed, surgical repair should be performed as soon as possible. In the acute phase, transabdominal surgical repair is preferred due to minimal trauma and faster recovery. In the late stage (third stage) or when complicated by intestinal strangulation or perforation, a transthoracic approach is more suitable. This allows easier decompression of the injured gastrointestinal tract within the thoracic cavity, facilitates perforation repair or adhesion release, and enables thorough cleaning of the contaminated pleural cavity.

bubble_chart Differentiation

This disease should be differentiated from hydropneumothorax, diaphragmatic eventration, etc.