Jul 27, 2008

Congenital Diaphragmatic Hernia


Congenital diaphragmatic hernia is a birth defect in which there is hole in a portion of diaphragm causing abdominal organs to go up in the thoracic cavity.This causes lung compression & respiratory distress in a newborn.


1 : 2000-5000 live birth
8 % of all major congenital anomalies
The cause of CDH is largely unknown

Prenatal Diagnosis:

Fetal USG shows stomach, intestines, liver, kidneys & spleen in the chest cavity
Abnormal position of certain viscera inside the abdomen
Stomach visualization out of its usual position
Intrauterine growth retardation
Polyhydramnios, Fetal hydrops

Clinical Presentation:

The newborn presents with severe respiratory distress

On examination:

Respiratory distress
Scaphoid abdomen
Auscultation of the lungs reveals poor air entry
Shift of the heart to the side opposite


Plain X-ray abdomen (erect) - shows the bowel loops in the thoracic cavity with compression of ipsilateral lung.

Ultrasonography of chest - will confirm the presence of the bowel & other viscera

2-D echo & Renal USG- To rule out associated cardiac & renal anomalies.


Mechanical ventilation
Nitric Oxide

Surgical management: By abdominal or thoracic approach the intestinal contents are placed in the abdomen & the hole in the diaphragm is sutured.