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Bochdalek hernia is a birth defect where the diaphragm doesn’t close properly, causing abdominal organs to push into the chest cavity. Emergency surgery is needed to move the organs and close the opening. Causes are unknown, but genetic mutations, vitamin A deficiency, or metabolic disorders may contribute. Diagnosis is made through physical exams and imaging tests. Treatment involves stabilizing breathing and surgery to repair the hernia.
A Bochdalek hernia is a potentially life-threatening birth defect in which the diaphragm does not close properly. As a result, abdominal organs and other tissue may push up into the chest cavity. A baby who is born with a Bochdalek hernia may have extreme breathing difficulties due to underdeveloped lungs and pressure from bulging organs. Emergency surgery is often needed to move the abdominal contents into their normal alignment and permanently close the opening in the diaphragm. Most children who receive prompt treatment are able to recover and develop normally.
The causes of Bochdalek’s hernias aren’t fully understood, but doctors believe that several factors can contribute to diaphragm deformities. A hernia can occur due to a random genetic mutation affecting organ development, a vitamin A deficiency, or an inherited metabolic disorder. The lower part of the diaphragm usually closes around the eighth week of gestation, and the developmental problems that cause hernias are thought to show up about two weeks earlier. It is common for babies to be born with additional problems as well, such as heart defects or significantly underdeveloped lungs.
Sometimes it’s possible for doctors to detect a Bochdalek hernia with ultrasound and other imaging tests while the fetus is still in the uterus. In most cases, however, a baby is not known to have a major problem until it is born. At birth, the baby may show signs of difficulty breathing and a rapid heartbeat. His skin may have a blue tint due to lack of oxygen in the bloodstream. Babies may also be floppy and unable to cry and open their eyes.
A team of doctors can diagnose a Bochdalek hernia quickly by performing a physical exam. The abdomen typically feels hollow and easy to compress when the organs are too far up in the chest. A doctor may also be able to hear bowel sounds in the chest using a stethoscope. If the patient is stable enough, chest x-rays or computed tomography may be done to confirm a diaphragm deformity.
The first goal of treatment is to stabilize breathing with oxygen therapy or cardiopulmonary resuscitation. If your heart isn’t working properly, you may need a bypass machine to preserve blood circulation. Surgery to repair a Bochdalek hernia is a delicate procedure that involves cutting out the chest cavity and manually fastening the bowels, kidneys, stomach, and other organs. The hole in the diaphragm is then sutured and the surgical wound is closed. Round-the-clock monitoring and treatment are important in the days following surgery to make sure no complications occur.
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