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The diaphragm is a large dome-shaped muscle that separates the chest cavity (where your heart and lungs are) from the belly area. The diaphragm is a very important muscle for breathing.
A diaphragmatic hernia is an opening or tear in the diaphragm. Diaphragmatic hernias in babies are very rare and occur in one out of every 4,000 births.
In a child born with a diaphragmatic hernia, the organs from the belly (stomach, spleen, liver, and intestines) may go up into the chest cavity where the lungs are. These abdominal organs take up the space and prevent the lung from growing normally. The result is that the lung remains too small for children to breathe on their own when they are born. Diaphragmatic hernia repair is surgery to correct this birth defect.
Surgery is done while your child is under general anesthesia (asleep and not able to feel pain). The surgeon makes a surgical cut in the abdomen under the upper ribs to be able to reach the organs of the abdomen. Then the surgeon gently pulls these organs down into place through the opening in the diaphragm and into the abdominal cavity.
The surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches, but in most cases a piece of plastic patch is used to cover the hole in the diaphragm.
After surgery, a tube from the chest will remain in place for a few days to allow air, blood, and fluid to drain. The increased room in the chest will now allow the lungs room to expand.
A diaphragmatic hernia can be life threatening. Surgery to repair it must be done in the first few days or weeks of a child' s life.
Ehrlich PF, Coran AG. Diaphragmatic hernia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 101.
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