Congenital Diaphragmatic Hernia and Eventration

Abstract

Congenital diaphragmatic hernia (CDH) is a malformation characterized by a defect in the posterolateral diaphragm, the foramen of Bochdalek, through which the abdominal viscera migrate into the chest during fetal life. The reported incidence of CDH varies from 1 in 2200 to 1 in 5000 births. In most series, 80% of posterolateral diaphragmatic hernias have been reported to occur on the left side and 20% on the right side. Bilateral CDH is rare. The size of the defect varies from small (2 or 3 cm) to very large, involving most of the hemidiaphragm. A rim of muscle is usually present around the defect, which is often covered posteromedially with peritoneum. A hernial sac, composed of pleura and peritoneum, has been reported in about 20% of patients. Despite remarkable progress in resuscitation and intensive care, the mortality and morbidity in CDH still remains high. The high morbidity and mortality rates are attributed to severe lung hypoplasia and/or persistent pulomnary hypertension.