Diaphragmatic
Hernia / Eventration

Learn symptoms, causes, management of pediatric Diaphragmatic Hernia and Eventration, and when to contact a pediatric surgeon in Singapore.

What Is Diaphragmatic Hernia or Eventration in Children?

The diaphragm is a dome-shaped muscle that separates the chest from the abdomen. It plays a vital role in breathing by moving up and down to help the lungs expand and contract. Two conditions can affect the diaphragm in children: diaphragmatic hernia and diaphragmatic eventration.

Diaphragmatic Hernia

A diaphragmatic hernia occurs when there's a hole or weak spot in the diaphragm. This opening allows organs from the abdomen (like the stomach, intestines, or liver) to push up into the chest cavity where the lungs and heart are located. When abdominal organs move into the chest, they can press on the lungs and prevent them from growing and working properly.
The most common type in babies is called congenital diaphragmatic hernia (CDH), which is present at birth. This condition requires neonatal hernia repair and specialized multidisciplinary CDH care. Some diaphragmatic hernias can also happen later due to injury or trauma.

Diaphragmatic Eventration

Diaphragmatic eventration is different. Instead of a hole, part of the diaphragm is abnormally thin and weak. This weak section bulges upward into the chest like a balloon. The thin diaphragm can't contract properly, which may affect breathing. Like hernias, eventration can be present at birth or develop later.
Both conditions may need diaphragmatic hernia repair to help your child breathe normally and develop properly.

Common Symptoms of Diaphragmatic Hernia and Eventration

Symptoms depend on how severe the condition is and how much it affects the lungs.

Diaphragmatic Hernia Symptoms

In newborns with congenital diaphragmatic hernia, symptoms include:

Difficulty breathing right after birth
Rapid, shallow breathing
Blue or purple skin color (cyanosis) due to low oxygen
Chest looks uneven - one side may appear larger
Belly looks sunken or flat because organs have moved up to the chest
Fast heart rate
Trouble feeding and poor weight gain in milder cases

In older children with diaphragmatic hernia from injury, it presents as:

Sudden breathing difficulty after trauma
Chest or abdominal pain
Difficulty eating or abdominal discomfort
Bowel sounds heard in the chest when doctors listen with a stethoscope

Diaphragmatic Eventration Symptoms

Many children have no symptoms, especially with small eventrations. When symptoms do occur, they include:

Shortness of breath during activity or even at rest
Frequent respiratory infections like pneumonia or bronchitis
Fatigue and tiring easily during play
Feeding difficulties in babies
Poor weight gain in infants
Chest infections that keep coming back

When to Seek Care

Newborns with severe congenital diaphragmatic hernia need immediate neonatal hernia repair and multidisciplinary CDH care in the hospital. For older children, contact us if your child has ongoing breathing problems, gets tired very easily, has frequent chest infections, or experienced chest or abdominal trauma. We'll evaluate whether diaphragmatic hernia repair is needed.

What Causes Diaphragmatic Hernia and Eventration?

Diaphragmatic Hernia Causes

Congenital (Present at Birth): The most common cause is incomplete development of the diaphragm during pregnancy. Between weeks 8-10 of pregnancy, the diaphragm forms from several parts that should fuse together. When fusion doesn't happen completely, a hole remains. This is called congenital diaphragmatic hernia (CDH).
The exact reason this happens isn't fully known, but it may involve genetic factors, environmental factors during pregnancy, or random developmental variations. About 1 in 2,500 babies is born with CDH, requiring specialized multidisciplinary CDH care.

Acquired (Develops Later): Less commonly, diaphragmatic hernia can develop after birth due to severe chest or abdominal trauma from car accidents or major falls, surgical complications affecting the diaphragm, or penetrating injuries to the chest or upper abdomen.

Diaphragmatic Eventration Causes

Congenital: Some babies are born with a thin, weak area of diaphragm. The reason is often unknown. The diaphragm simply didn't develop with normal thickness and strength.

Acquired: Eventration can develop later from damage to the nerve controlling the diaphragm (from birth injury, surgery, or infection), neuromuscular disorders affecting muscle function, or trauma to the chest or neck.

Important Points for Parents

Neither condition is caused by anything you did during pregnancy. These are developmental variations or injuries that couldn't be prevented. With proper care including neonatal hernia repair when needed and multidisciplinary CDH care, most children do very well.

Consequences of Untreated Diaphragmatic Hernia and Eventration

Both conditions can significantly impact a child's health if not properly treated.

Breathing Problems

In Diaphragmatic Hernia: The displaced abdominal organs press on the lungs, preventing them from expanding fully. In severe cases, the lungs don't develop normally (called pulmonary hypoplasia - small, underdeveloped lungs). Without timely neonatal hernia repair and multidisciplinary CDH care, babies can't get enough oxygen. Older children with acquired hernias have progressive difficulty breathing as more organs shift into the chest.

In Eventration: The weak, elevated diaphragm can't help the lungs expand properly. This leads to reduced lung capacity, difficulty breathing with activity, and increased work of breathing that causes fatigue.

Lung Infections

Both conditions make it harder to clear mucus from the lungs, increasing the risk of frequent pneumonia and bronchitis, chronic lung infections, and long-term lung damage if infections are severe or recurrent.

Heart Problems

In severe cases, especially with large diaphragmatic hernias, the displaced organs can press on the heart and major blood vessels. This may cause abnormal heart position and function, increased pressure in the blood vessels going to the lungs (pulmonary hypertension), and strain on the heart that can become serious.

Feeding and Growth Issues

Babies and young children may have difficulty feeding due to breathing problems, poor weight gain and growth delays, digestive problems if the stomach or intestines are affected, and vomiting or reflux when abdominal organs are displaced.

Emergency Situations

Long-term Complications

Without treatment, children may develop chronic breathing difficulties lasting into adulthood, permanent lung damage or underdevelopment, scoliosis (curved spine) from chest abnormalities, and reduced exercise tolerance affecting quality of life.
The good news is that with proper diagnosis and treatment, including thoracoscopic diaphragmatic repair or open surgery when needed, most children can lead normal and active lives.

How to Treat Diaphragmatic Hernia and Eventration

Treatment depends on the type and severity of the condition. At The Little Surgery, Dr. Ong Lin Yin provides expert care including evaluation, surgical diaphragmatic hernia repair, and coordination of multidisciplinary CDH care when needed.

Treatment for Diaphragmatic Hernia

For Congenital Diaphragmatic Hernia (CDH) in Newborns
Babies with CDH need immediate, specialized care from a team of experts. This is why multidisciplinary CDH care is so important.

Immediate stabilization: After birth, the baby needs breathing support with a ventilator to help oxygen get to the body, medications to support blood pressure and heart function, a tube in the stomach to prevent it from filling with air, and careful monitoring in the neonatal intensive care unit (NICU).
Multidisciplinary CDH care: Treatment involves specialists working together including neonatologists (newborn doctors), pediatric surgeons, respiratory therapists, cardiologists, nutritionists, and others as needed. This team approach ensures every aspect of your baby's care is coordinated.
Neonatal hernia repair: Once the baby is stable (usually within the first few days to weeks of life), surgery is performed to repair the diaphragm. The timing depends on how stable the baby is. The surgery moves the abdominal organs back where they belong and closes the hole in the diaphragm. Sometimes a patch is needed to close large defects.
After surgery: Babies typically stay in the NICU for several weeks to months, depending on severity. They need continued breathing support that's gradually reduced, help with feeding and nutrition, monitoring for complications, and ongoing multidisciplinary CDH care as they grow.

For Acquired Diaphragmatic Hernia

Hernias from trauma or occurring later in life also need diaphragmatic hernia repair, though the urgency and approach may differ.

Evaluation: We use imaging studies like X-rays, CT scans, or ultrasound to see the hernia clearly and understand which organs are displaced.
Surgery: Repair is usually needed to prevent complications. The surgery moves organs back to the abdomen and repairs the diaphragm opening. Depending on the location and size, this may be done through thoracoscopic diaphragmatic repair (minimally invasive) or open surgery.

Treatment for Diaphragmatic Eventration

Observation: Small eventrations that don't cause symptoms may just be watched over time with regular check-ups and imaging to monitor for changes.
Conservative management: For mild symptoms, treatment may include breathing exercises and physical therapy, treatment of respiratory infections, and nutritional support to help with growth.
Surgical repair: When eventration causes significant symptoms or complications, surgical diaphragmatic hernia repair (technically called diaphragmatic plication) is recommended. This surgery tightens and reinforces the weak part of the diaphragm, pulling it down to its normal position and preventing it from bulging up. This can often be done through thoracoscopic diaphragmatic repair, which is less invasive.

After diaphragmatic hernia repair, children typically stay in the hospital for several days to weeks, depending on the complexity. They may need breathing support initially, pain management, and gradual increase in feeding.
At home, most children recover well with time. Activity should be limited initially, gradually returning to normal as healing progresses. Follow-up visits are important to monitor healing, check breathing function, and watch for any complications.
With successful diaphragmatic hernia repair, most children go on to lead normal, active lives. Some may need ongoing follow-up, especially if they had severe CDH with lung underdevelopment. This is where continued multidisciplinary CDH care makes a difference.

Why Choose The Little Surgery for Diaphragmatic Hernia and Eventration Treatment

We provide expert surgical care for diaphragmatic conditions including thoracoscopic diaphragmatic repair when appropriate, traditional diaphragmatic hernia repair, neonatal hernia repair, and coordination of multidisciplinary CDH care.

Experienced Pediatric Surgeon

Dr. Ong Lin Yin has over 20 years of experience in paediatric surgery, including treatment of complex diaphragmatic conditions. As the former Head of Paediatric Surgery at KK Women's and Children's Hospital, she has successfully performed numerous diaphragmatic hernia repair procedures with excellent outcomes.

Comprehensive Care

We provide thorough assessment including detailed examination, appropriate imaging studies to understand the condition fully, and evaluation of how the condition affects breathing, heart function, and overall health.
Dr. Ong is skilled in both traditional open diaphragmatic hernia repair for complex cases and thoracoscopic diaphragmatic repair when appropriate for minimally invasive treatment. She determines the best approach for each child based on their specific condition.
For complex cases, especially congenital diaphragmatic hernia requiring neonatal hernia repair, we work closely with other specialists as part of multidisciplinary CDH care. This team approach ensures comprehensive treatment addressing all aspects of your child's condition including respiratory support, cardiac care, nutritional needs, and developmental support.

Family Support

We understand that these conditions can be overwhelming for families. Dr. Ong provides clear explanations of the condition, treatment options and surgical approach, what to expect during recovery, along with compassionate support throughout the treatment journey. As a mother herself, she understands family concerns and ensures you feel informed and supported.

Contact The Little Surgery Today

If your child has been diagnosed with diaphragmatic hernia or eventration, or if you're concerned about breathing difficulties, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.

Diaphragmatic Hernia / Eventration