THORACOABDOMINAL / HERNIA · CONDITION GUIDE

Diaphragmatic Hernia

Q: Is diaphragmatic hernia always from birth?

No. While congenital diaphragmatic hernia (CDH) presents at birth and is managed by paediatric surgeons, diaphragmatic hernias in adults are usually acquired — resulting from traumatic rupture, enlargement of congenital defects over time, or iatrogenic injury. Adult diaphragmatic hernias are often diagnosed years after the precipitating event.

Q: What organs can be found in the chest in a diaphragmatic hernia?

Any abdominal organ may herniate through a diaphragmatic defect, including loops of bowel (small and large), stomach, spleen, kidney, and omentum. The left side is more commonly affected in traumatic and congenital hernias, as the liver protects the right hemidiaphragm from herniation.

Q: What happens if a diaphragmatic hernia is left untreated?

Untreated diaphragmatic hernias progressively enlarge as more abdominal organs herniate into the chest. This leads to worsening respiratory compromise from lung compression, increased risk of bowel obstruction or strangulation, and cardiac displacement. All symptomatic diaphragmatic hernias and those containing bowel should be repaired.

A defect in the diaphragm allowing abdominal organs to herniate into the chest — requiring surgical repair to restore organ position and prevent respiratory and gastrointestinal compromise.

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Surgical Repair for Diaphragmatic Hernia by Dr. Tagore

Rare in Adults ACQUIRED OR CONGENITAL

1–3 Hours PROCEDURE DURATION

2–5 Days HOSPITAL STAY

ABOUT THIS CONDITION

What is Diaphragmatic Hernia?

A diaphragmatic hernia (excluding hiatal hernia) occurs when abdominal organs herniate through a congenital or acquired defect in the diaphragm into the thoracic cavity. Congenital diaphragmatic hernia (CDH) presents at birth with respiratory compromise. In adults, acquired diaphragmatic hernias result from traumatic rupture of the diaphragm following blunt or penetrating injury, or from enlargement of a Morgagni or Bochdalek foramen. They may contain bowel, stomach, spleen, or colon. Dr. Tagore Mohan Grandhi repairs acquired diaphragmatic hernias at Lux Hospitals, Hyderabad. Laparoscopic or thoracoscopic repair reduces the herniated organs, repairs the diaphragmatic defect with primary suture or mesh, and restores normal thoracic and abdominal anatomy. Emergency repair is undertaken for acute presentations with respiratory compromise or bowel strangulation.

SIGNS TO WATCH

Common Symptoms

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Symptoms that need attention

Recurrent respiratory symptoms — shortness of breath, reduced exercise tolerance Chest pain or discomfort from herniated abdominal organs Postprandial fullness, nausea, or vomiting from bowel in the chest Absent breath sounds and bowel sounds in the chest on auscultation Acute respiratory distress in large or acutely strangulated hernias Discovered incidentally on chest X-ray or CT in many cases

WHY IT HAPPENS

Causes & Risk Factors

Traumatic diaphragmatic rupture from blunt abdominal or thoracic injury
Penetrating injury — stab or gunshot wound traversing the diaphragm
Enlargement of congenital foramina (Morgagni or Bochdalek) in adulthood
Previous diaphragmatic surgery creating weaknesses
Extremely high intra-abdominal pressure events (severe crush injury)
Iatrogenic injury during laparotomy, thoracotomy, or chest drain insertion

CLINICAL DETAILS

KeyFacts

Cause in Adults

Trauma or enlargement of congenital foramina

Contents

Bowel, stomach, spleen, or colon may herniate

Surgical Approach

Laparoscopic or thoracoscopic repair preferred

Emergency

Acute respiratory compromise requires urgent repair

Mesh Use

Mesh reinforcement for large or complex defects

Hospital

Available at Lux Hospitals, Hitech City, Hyderabad

HOW WE TREAT IT

Treatment Approach

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Laparoscopic Diaphragmatic Repair

Laparoscopic diaphragmatic hernia repair reduces the herniated organs into the abdomen, inspects bowel viability, and closes the diaphragmatic defect with sutures and mesh reinforcement. Dr. Grandhi performs laparoscopic repair as the preferred minimally invasive approach for stable patients, achieving durable repair with a shorter hospital stay than open surgery.

Available at Lux Hospitals, Hitech City, Hyderabad

1

Diagnosis & Imaging

Chest X-ray may reveal bowel gas in the thorax. CT thorax and abdomen defines the defect location, herniated contents, and any associated injuries. Lung function assessment is performed in chronic presentations.
2

Urgency Assessment

Acute respiratory compromise, bowel obstruction, or strangulation requires emergency repair. Stable chronic hernias are repaired electively after optimisation of respiratory function.
3

Laparoscopic or Open Repair

Herniated organs are reduced into the abdomen laparoscopically. Bowel viability is assessed and resection performed if required. The diaphragmatic defect is closed with sutures and mesh reinforcement for large defects.
4

Post-operative Respiratory Care

Chest physiotherapy and incentive spirometry are commenced post-operatively. Respiratory function typically improves progressively as the reduced lung re-expands. Follow-up CT confirms repair integrity.

AVAILABLE TREATMENTS

TreatmentOptions

Laparoscopic Hernia Repair

Minimally invasive reduction of herniated organs and closure of the diaphragmatic defect with sutures and mesh. Preferred approach for stable patients.

Hernia Repair (Open)

Open abdominal or thoracic approach for emergency repair, complex defects, or where laparoscopic repair is not feasible due to bowel strangulation or extensive adhesions.

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COMMON QUESTIONS

Frequently Asked Questions

Is diaphragmatic hernia always from birth?+

What organs can be found in the chest in a diaphragmatic hernia?+

What happens if a diaphragmatic hernia is left untreated?+

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