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 that time - Ambroise Paré. This term should be understood as the penetration of certain internal organs through defects in the diaphragm.
You should know that with some violations,arising from complications in fetal embryonic development, 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 diaphragm membrane, 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 muscle, is the site 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. rare hernia of natural openings.
If the diaphragmatic hernia, the symptoms of whichare directly connected with the received traumas or wounds, is subdivided only on false and true, non-traumatic hernias have a wider 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 true hernia of weak areas, the diaphragm ishernia of the sternum-costal 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 sternal zone of the diaphragm.
Extremely rare hernia vena cava, cracks of the sympathetic nerve and aorta. The most common species (about 98% of all cases) is the diaphragmatic hernia of the esophagus.
It has its anatomical features. There are several types of this disease. Such 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.
Paraesophageal hernia, like a sliding one, canbe congenital and acquired, but the congenital hernia is rarer than 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 the cause of hernia formationtwo factors. One of them is a pulsation factor, in which a hernia is formed due to an increase in intra-abdominal pressure (severe 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 played by an X-ray study. Diaphragmatic hernia is subdivided in 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.
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