The diaphragm is the muscle that stretches along the bottom of the rib cage and plays a crucial role in respiration. When the diaphragm is damaged, it must be immediately repaired. There are several ways in which the diaphragm may be injured, all eventually involving hiatal herniation.
In a rare birth defect, an infant is born with a hole in the diaphragm which requires immediate repair. Since the diaphragm separates the chest cavity from the abdominal area, when there is a hole, or hernia, present the abdominal organs may invade the chest cavity, interfering with breathing and normal lung development.
Until the surgical correction surgery is performed, the infant almost always needs a breathing device to assist in respiration. Once the surgery is performed and the hole is closed, the infant is able to breathe normally.
Severe Hiatal Herniation
Hiatal herniation, in which the abdominal organs protrude into the chest cavity, may also result from the aging process. Its symptoms may remain mild and respond well to dietary changes and medication, but when a hiatal hernia causes severe symptoms, particularly when it causes respiratory difficulties, surgical intervention may be necessary.
Blunt force trauma or penetrating trauma can actually rupture the diaphragm. Such trauma may occur through accident or as a result of deliberate attack. Since the pressure in the abdomen is higher than the pressure in the chest, physical trauma to the diaphragm region will also almost certainly result in hiatal herniation and require immediate surgical repair.
Symptoms of a Diaphragm Injury
There are several signs of diaphragm rupture that may include the following.
- Diminished breathing signs on the affected side
- Chest pain
- Abdominal pain
- Acid reflux
- Breathlessness (dyspnea)
- Sepsis, in severe cases
- Bowel sounds in the chest
- Symptoms of bowel obstruction
- Tachycardia or rapid heart beat
- A bluish skin color (cyanosis)
Diagnosis of a Diaphragm Injury
An injury to the diaphragm is often difficult to diagnose since the symptoms may be similar to those found in other conditions. Diagnostic tests including X-ray, CT scan or ultrasound may be employed to pin down the cause of symptoms. Under certain circumstances, an exploratory laparotomy, a surgical procedure in which a large incision is made in the abdomen, may be performed to make an accurate diagnosis and immediate repair.
The Diaphragm Repair Procedure
This procedure may be done as open surgery, but is most often performed laparoscopically. The latter requires only small incisions and results in less pain, less scarring, and a shorter recovery time. Sometimes the surgical repair is performed by suturing the patient's own tissue only. Other times, surgical mesh is employed to repair the diaphragm.
Risks of a Diaphragm Repair
With any surgery risks are present, including the following:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
In the case of diaphragm repair, breathing problems are particularly dangerous and include the risk of the following:
- Collapsed lung or pneumothorax
- Lung problems that do not resolve
- Respiratory failure
Recovery from a Diaphragm Repair
After a repair of the diaphragm, the patient can usually return home in a day or two. The patient will be given pain medication and be instructed to limit physical activity and heavy lifting for about a month. The following symptoms after surgery should be reported to the doctor immediately:
- Severe pain at the surgical site
- High fever
- Difficulty breathing or swallowing
- Swelling, redness or odor at the incision site
- Absence of bowel movement for 3 days