Diaphragmatic hernia - what is the cause of this?

The first mention of "diaphragmatic hernia" dates back to the 16th century. It belongs to the famous healer of the time - Ambroise Paré. This term should be understood as the penetration of certain internal organs through defects in the diaphragm.

It should be noted that with some disorders that occur in complications in embryonic development of the fetus, partial or complete defects of the diaphragm in newborns may occur. In the event that these disorders occur before the moment of formation of the diaphragm, the hernia will not have a hernial sac. With deviations in development that occurred even after the formation of the membrane of the diaphragm, penetration of the hernial sac consisting of serous membranes through the hernial gates that do not contain muscles occurs.

The area of connection of the costal part with the sternum, which is devoid of muscles, is the place of the birth of the sternum-rib hernia. Otherwise they are called sternocostal hernias. This vulnerable place is called the Larrae sternocosteal triangle, and the hernias that have arisen there are also called the hernia of Larray's triangle.

Diaphragmatic hernia can be caused by various reasons. Let's say that this disease was classified by B.V. Petrovsky, thus:

1. Hernia, resulting from injuries (traumatic hernia):

- false;

- true.

2. non-traumatic hernia:

- congenital falsehood;

- a true hernia of the weak zone of the diaphragm;

- diaphragmatic hernia of natural openings:

- a true hernia of atypical localization;

3. hernia of the esophageal opening;

4. a rare hernia of natural openings.

If the diaphragmatic hernia, the symptoms of which are directly related to the resulting injuries or injuries, is divided only into false and true, then non-traumatic hernias have a broader classification. The only false is the congenital hernia, which arises because of defects in the diaphragm (non-enlargement of the abdominal and thoracic cavities).

To the true hernia of the weak zones of the diaphragm is the hernia of the region of the sternal-rib triangle. In this area, the thorax is separated from the peritoneum by a thin plate of connective tissue located between the peritoneum and the pleura.

Retrostenal hernia is characteristic of the underdeveloped region of the chest zone of the diaphragm.

Extremely rare hernia vena cava, cracks of the sympathetic nerve and aorta. The most common variety (about 98% of all cases) is the diaphragmatic hernia of the esophagus.

It has its anatomical features. There are several types of this disease. These hernias are: sliding, with a change in the esophagus (with a shortening, without shortening); Cardiac; Subtotal; Cardiofundal; Total.

The existing parasophageal hernia is divided into: intestinal, omental, fundal, intestinal-gastric.

Specialists distinguish:

1. congenital "shortened esophagus";

2. Paraesophageal hernia, in which part of the stomach is located on the side of the usually located esophagus;

3. Hernia of the esophageal opening slipping, in which the esophagus with the cardiac zone of the stomach can be drawn into the chest cavity.

A parasophageal hernia, like a sliding hernia, can be congenital and acquired, but congenital hernias are rarer than those acquired. People who have reached the age of 40 are much more likely to have acquired hernias. Of great importance is the age-induced involution of the tissues, leading to an expansion of the esophageal opening and a weakening of the connections of the diaphragm and esophagus.

Most often, two factors cause the hernia. One of them is a pulsation factor, in which a hernia is formed due to an increase in intra-abdominal pressure (heavy physical exertion, flatulence, overeating, pregnancy, constant wearing of tight belts). Another factor - traction, is associated with the hypermotorics of the esophagus, caused by frequent vomiting.

A decisive role in determining the diagnosis is roentgenologic research. Diaphragmatic hernia is subdivided by diameter into small (up to 3 cm), medium (from 3 to 8 cm) and large (more than 8 cm).

Diaphragmatic hernia, the treatment of which can not yield the desired result by conservative methods, is best treated by surgical methods.