About diaphragmatic hernia true is:
|A||Stomach along may come|
|B||It can be present only at birth|
|C||Defect in crura|
|D||Distension of intestine can lead to diagnosis|
a. Most CDH defects are on the left side (80%); however, up to 20% may occur on the right side. A CDH may also be bilateral, but this is distinctly rare.
b. The cause for CDH is unknown, but it is thought to result from failure of normal closure of the pleuroperitoneal canal in the developing embryo. As a result, abdominal contents herniate through the resultant defect in the posterolateral diaphragm and compress the ipsilateral developing lung.
c. The posterolateral location of this hernia is known as Bochdalek's hernia and is distinguished from the congenital hernia of the anteromedial, retrosternal diaphragm, which is known as Morgagni's hernia.
d. Compression of the lung results in pulmonary hypoplasia involving both lungs, with the ipsilateral lung being the most affect.
e. The diagnosis of CDH is frequently made at the time of a prenatal ultrasound during an otherwise unremarkable pregnancy.
f. The postnatal diagnosis is relatively straightforward; a plain chest radiograph demonstrates the gastric air bubble or loops of bowel within the chest
g. There may also be a mediastinal shift away from the side of the hernia or polyhydramnios from the obstructed stomach. Rarely is an upper gastrointestinal contrast study necessary.
h. Most pediatric surgeons wait for a variable period of time (24-72 hours) to allow for stabilization of the infant before embarking on surgical repair.