Diaphragmatic hernia natural history, complications, and prognosis

Diaphragmatic hernia Main page
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Diaphragmatic hernia from other Diseases
Epidemiology
Risk factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Radiological tests
Treatment
Medical treatment
Surgical treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

If left untreated, congenital diaphragmatic hernia can be fatal due to pulmonary hypoplasia and severe pulmonary hypertension. Common complications include volvulus, pulmonary hypoplasia, and pulmonary hypertension. The prognosis is dependent on the size and site of the defect with mortality ranging from 25-60% of the cases.

Natural history, complications and prognosis

Natural history

• 90% of the cases of congenital diaphragmatic hernia presents in the neonatal period.
• If left untreated, congenital diaphragmatic hernia can be fatal due to pulmonary hypoplasia and severe pulmonary hypertension.

Complications

GI complications

• Abnormal developmental rotation of the midgut
• Midgut volvulus
• Gastric volvulus

Cardiopulmonary complications

• Pulmonary hypoplasia
• Pulmonary artery hypertension
• In severe cases, ventricular hypoplasia

Prognosis

• The prognosis is mainly dependent on the size of the defect and the degree of the herniation.
• The presence or absence of liver herniation on fetal MRI is the most reliable prediction of the postnatal survival.
• The estimation of fetal lung volume and lung area to head circumference is a useful indicator of the prognosis of the disease in the absence of liver herniation.
• The mortality ranges from 25-60% of the cases.