ConditionDigestive system
Diaphragmatic Hernia
A diaphragmatic hernia is a hole or weakness in the diaphragm, the dome-shaped muscle that separates the chest from the abdomen, through which abdominal organs such as the stomach, bowel, spleen or liver move into the chest. It can be congenital, present at birth, or acquired, usually after a car crash, fall or stab wound. Symptoms range from none to severe breathing difficulty or a trapped, strangulated bowel. Most need surgical repair.
Also called: Hernia of the diaphragm, congenital diaphragmatic hernia, acquired diaphragmatic hernia, traumatic diaphragmatic hernia
At a glance
- What it is
- Abdominal organs pushing into the chest through a defect in the diaphragm.
- Types
- Congenital (Bochdalek, Morgagni) and acquired (traumatic or after surgery). Hiatal hernias are a separate, very common type.
- Symptoms
- Breathlessness, chest or upper abdominal pain, vomiting, or none at all.
- Diagnosis
- Chest X-ray and CT scan. Prenatal ultrasound for congenital cases.
- Treatment
- Surgical repair, urgently if bowel is trapped or blood supply is cut off.
When to get help
Call 911 or go to the ER
- Severe chest or upper abdominal pain with vomiting, inability to pass gas or stool, or retching without bringing anything up (possible strangulated bowel)
- Severe breathlessness after a crash, fall or stab wound to the chest or upper abdomen
- A newborn with severe breathing difficulty and a sunken belly
See a doctor within a day or two
- New breathlessness or abdominal pain weeks to years after a chest or abdominal injury
- Breathlessness and pain after eating, in someone with a known diaphragmatic hernia
Book a routine appointment
- A hernia found incidentally on imaging
- Recurrent chest infections or vague upper abdominal symptoms with a known diaphragm defect
Types of diaphragmatic hernia
| Type | Cause | Typical age | Features |
|---|---|---|---|
| Bochdalek (congenital) | Defect at the back and side, usually left | Newborns | Severe breathing problems, small lungs |
| Morgagni (congenital) | Defect at the front, near the breastbone | Children or adults | Often few symptoms, found incidentally |
| Traumatic | Tear from blunt or penetrating injury | Any age | May be missed initially and found later |
| Iatrogenic | After chest or abdominal surgery | Adults | Weakness at a surgical site |
| Hiatal | Stomach slides through the esophageal opening | Adults | Reflux, very common, usually considered separately |
Congenital diaphragmatic hernia in newborns is covered in detail on the congenital diaphragmatic hernia page. A hiatal hernia is technically a diaphragmatic hernia, but it is usually discussed separately because it is common and mainly causes reflux.
Traumatic diaphragmatic hernia
A forceful blow to the abdomen, such as a car crash or a fall from height, suddenly raises abdominal pressure and can tear the diaphragm. Stab and gunshot wounds can cut it directly. Most traumatic tears are on the left, because the liver protects the right side.
Small tears are easily missed in the first hours after an injury, especially when other injuries take priority and the person is on a ventilator. Because the chest has lower pressure than the abdomen, organs gradually move upward, and the hernia may only be found months or years later when bowel becomes trapped. See diaphragmatic rupture.
Symptoms
Symptoms depend on the size of the defect and which organs move:
- shortness of breath, especially lying flat or after eating
- chest pain or upper abdominal pain
- a feeling of fullness after small meals
- nausea and vomiting
- bowel sounds heard in the chest
- reduced breath sounds on one side
Many Morgagni hernias and small traumatic tears cause no symptoms until complications occur.
Complications
- incarceration: organs become trapped
- strangulation: trapped bowel loses its blood supply, causing severe pain, vomiting and shock. This is an emergency
- gastric volvulus: the stomach twists, causing pain and retching without vomiting
- breathing problems from compressed lungs
Diagnosis
- chest X-ray: may show bowel loops or the stomach above the diaphragm, or a raised diaphragm outline
- CT scan: the main test. It shows the defect and which organs have moved
- contrast studies: swallowed contrast to outline the stomach and bowel
- MRI: sometimes, for clearer views of the diaphragm
- laparoscopy or thoracoscopy: a camera may be used to find or confirm small traumatic tears after penetrating injury
- prenatal ultrasound and fetal MRI for congenital cases
Treatment
Surgery
Most diaphragmatic hernias are repaired surgically because of the lifelong risk of organs becoming trapped. The surgeon:
- returns the organs to the abdomen
- checks bowel for damage and removes any dead segment
- closes the defect with stitches or, for large defects, a mesh patch
Surgery can be done through the abdomen, the chest, or by keyhole (laparoscopic or robotic) techniques, depending on the type and timing.
- acute traumatic tears are repaired during emergency surgery for the injury
- chronic traumatic hernias are often approached through the chest because of adhesions
- Morgagni hernias are usually repaired laparoscopically, even without symptoms, in fit patients
Recovery
After repair, most people stay in hospital several days. Breathing exercises and early walking help prevent chest infections. Heavy lifting is restricted for several weeks.
Outlook
Acquired and Morgagni hernias repaired before complications have an excellent outlook, and recurrence is uncommon. Strangulation carries much higher risk. Congenital Bochdalek hernias depend mainly on lung development, as described on the CDH page.
Frequently asked questions
What is a diaphragmatic hernia?
It is a hole or weakness in the diaphragm that allows abdominal organs such as the stomach, intestine, spleen or liver to move into the chest. It can be present from birth or caused by injury or surgery.
Can adults get a diaphragmatic hernia?
Yes. Adults can develop traumatic hernias after car crashes, falls or stab wounds, sometimes found years later. Congenital Morgagni hernias may first be discovered in adulthood. Hiatal hernias, a related type, are very common in adults.
What are the symptoms of a diaphragmatic hernia in adults?
Symptoms include breathlessness, chest or upper abdominal pain, feeling full quickly, nausea and vomiting. Some people have no symptoms until bowel becomes trapped, causing severe pain and vomiting, which is an emergency.
Is a diaphragmatic hernia the same as a hiatal hernia?
A hiatal hernia is one type of diaphragmatic hernia, where the stomach pushes through the normal opening for the esophagus. Other diaphragmatic hernias pass through abnormal holes or tears in the muscle and more often need surgery.
Does a diaphragmatic hernia need surgery?
Most do, because there is an ongoing risk of organs becoming trapped and losing their blood supply. Surgery returns the organs to the abdomen and closes the defect with stitches or mesh. Small hiatal hernias are usually managed without surgery.
Sources
This guide was written from current patient and clinical guidance, including:
- MedlinePlus: Congenital diaphragmatic hernia repair
- Eastern Association for the Surgery of Trauma (EAST): Practice management guideline on diaphragmatic injuries
- American College of Surgeons: Hernia repair
- National Organization for Rare Disorders (NORD): Congenital diaphragmatic hernia
- Merck Manual: Diaphragmatic hernia