25 Nov, 2015


Marcelo Gonçalves SOUSA
Cássio Virgílio Cavalcante OLIVEIRA
José Moreira dos SANTOS-NETTO
DOI: https://doi.org/10.1590/S0102-6720201500030023
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The congenital diaphragmatic hernia (CDH) is defined as an anatomical defect on diaphragm, which permits the herniation of abdominal viscera into the thorax4. The hernia occurs due to an incomplete occlusion of the pleuroperitoneal channel during the embrionary period. The main cause of the incomplete closure can be a genetic mutation, a teratogen or both.

In terms of anatomic location, the CDH can be classified as Bochdalek type when an incomplete pleuroperitoneal channel occlusion is found posterolaterally; as Morganni type, while the defect is seen retrosternally; and yet as a congenital transhiatal esophagic type hernia. Among them, the Bochdalek type is the most common, found in 78-90% of patients; the Morganni type, in 1,5-6% of cases; and transhiatal, 14-24%11.

In most cases, the clinical impact occurs in the neonatal period, since only 10% of hernias are diagnosed after this period7. In neonates, the clinical presentation is acute, providing a higher morbidity and mortality. In adulthood, symptoms, if any, are more insidious, vague and intermittent, affecting not only the pulmonary dynamics, but also the gastrointestinal function5.

Chest X-ray and CT scan may be used2,8,12.Nevertheless, CDH findings are incidental when performing radiological examinations for other reasons, with the right-sided Bochdalek hernia accounting for 68% of cases.9,13

In elective situations, the minimally invasive surgery, either via laparoscopic or thoracoscopic can be used, but with limited application in cases of right-sided hernia3,8. Minor defects, technically easier to fix, can be sutured normally; in the case of larger apertures, or even hemidiaphragmatic agenesis, the use of nonabsorbable polypropylene mesh is the only solution.

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