From the Guidelines
Diaphragmatic hernias can present with a range of symptoms, including dyspnea, abdominal pain, gastrointestinal symptoms, and respiratory distress, which can be life-threatening if left undiagnosed or untreated, as evidenced by the high mortality associated with delayed diagnosis and treatment 42, 1. The symptoms of diaphragmatic hernias can vary depending on the type of hernia, the size of the defect, and the organs involved.
- Common symptoms include: + Dyspnea, which is the most common symptom, occurring in up to 86% of patients 40, 41, 1 + Abdominal pain, which can range from mild to severe 40, 41, 1 + Gastrointestinal symptoms, such as nausea, vomiting, and bowel obstruction 38, 1 + Respiratory symptoms, such as coughing and chest pain 39, 1 The natural history of traumatic diaphragmatic injury with hernia formation can be divided into three phases: the acute phase, the latent phase, and the obstructive phase 20, 1.
- In the acute phase, up to 66% of traumatic diaphragmatic hernias may be missed due to associated injuries 42, 1
- In the latent phase, patients may experience nonspecific gastrointestinal and respiratory symptoms caused by the herniation of intra-abdominal viscera into the thoracic cavity 43, 1
- In the obstructive phase, visceral obstruction may progress to ischemia of the herniated organs, which can be life-threatening 43, 1 Delayed presentation of diaphragmatic hernias is common, and patients may be asymptomatic for decades before becoming symptomatic 44, 1.
- Nonspecific presentation may lead to misdiagnosis and inappropriate management, highlighting the importance of a high index of suspicion and prompt diagnostic evaluation 44, 1
From the Research
Diaphragmatic Hernia Symptoms
- Diaphragmatic hernia can present with a range of symptoms, from asymptomatic cases to serious respiratory or gastrointestinal symptoms 2, 3, 4.
- Clinical presentation may include respiratory symptoms such as dyspnea, and gastrointestinal symptoms such as dyspepsia 5.
- Atypical presentations, such as lumbar hernia, can also occur 2.
- The symptoms of diaphragmatic hernia can be acute or chronic, and may be related to the size and location of the hernia, as well as the presence of any complications 4.
- In some cases, diaphragmatic hernia may be asymptomatic, and may only be diagnosed incidentally during imaging studies for other conditions 3.
Diagnosis and Treatment
- Diagnosis of diaphragmatic hernia is typically based on clinical investigation, plain X-ray film, and computed tomography (CT) scan 2, 3, 4.
- Surgical repair is the treatment of choice for diaphragmatic hernia, and may involve open or laparoscopic approaches 2, 5, 6.
- The choice of surgical approach may depend on the size and location of the hernia, as well as the presence of any complications 6.
- In some cases, emergency surgery may be required to reduce morbidity and mortality 3.