Diaphragmatic hernia

Suseela Vavilala, MD

India

This is a 28-year-old-primigravida referred to our service at 36 weeks. A left-sided diaphragmatic hernia with herniation of stomach, small and large bowel was diagnosed. Some cardiac anomalies were suspected including dextroposition, ventricular septal defect, overriding of aorta, severe pulmonary stenosis (Tetralogy of Fallot). There was also a polyhydramnios. The parents were counseled.

A spontaneous vaginal delivery occurred at 38 weeks (2.780g, male, Apgar 3/7). The baby died two hours later. The postnatal karyotype was normal. The anatomopathological  study revealed:

• bilateral congenital diaphragmatic hernia including:
  • left side: stomach, duodenum, pancreas and spleen
  • right side: right lobe of the liver and gallbladder
• cardiac anomalies:
  • pulmonary atresia
  • ventricular septal defect (severe form of Tetralogy of Fallot)
  • atrial septal defect

Note the absence of the stomach in the abdominal section

The ventricular septal defect and the stomach close to the heart

Babygram. Note bowel loops in the chest

Note the lung hypoplasia

Cardiac dissection: Note the pulmonary atresia with ventricular septal defect (thin pulmonary artery)