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Diaphragmatic hernias: a clinical and surgical challenge




Diaphragmatic hernias are defined as the passage of abdominal contents into the thoracic cavity through a diaphragmatic anatomical defect. They are classified as congenital (anterior or Morgani´s), posterolateral (or Bochadalek´s), and acquired (traumatic).


Congenital diaphragmatic hernias produce pulmonary hypoplasia and pulmonary hypertension in the newborn, which are associated with life-threatening physiologic complications. Prenatal diagnosis can be established trough different imaging techniques. Treatment includes respiratory stabilization of the newborn, followed by surgical repair of the anatomic defect.


Traumatic diaphragmatic hernias result from blunt or penetrating trauma. Penetrating trauma over the thoracoabdominal region is the most common cause. Sensibility of diagnostic images is not high, a fact that interferes with diagnosis. However, laparoscopy and thoracoscopy yield better diagnostic accuracy and also constitute a treatment approach. Surgical correction, by the abdominal or the thoracic approach, has to be performed as soon as diagnosis is established.


Key words: diaphragm; hernia, diaphragmatic; thoracic injuries; thoracic surgery; thoracic surgery, videoassisted.




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