Left Congenital Diaphragmatic Hernia without Hernial Sac vs. Left Congenital Diaphragmatic Hernia with Hernial Sac

Left Congenital Diaphragmatic Hernia without Hernial Sac vs. Left Congenital Diaphragmatic Hernia with Hernial Sac

Left picture: The diagnosis is a large congenital (pleuroperitoneal) diaphragmatic hernia (Bochdalek´s hernia). In the back and laterally only a small rim of the edge of the diaphragmatic defect is recognizable. Right picture: Here, the diagnosis is a congenital diaphragmatic hernia, too; but the hernia is not large, and in contrast to the diaphragmatic defect of the contralateral patient, a very large hernial sac is recognizable which has been opened and must be resected prior to closure of the defect. Theoretically, such a diaphragmatic hernia with a hernial sac can be missed at surgery, or in case of a large diaphragmatic defect, misinterpreted as a congenital diaphragmatic eventration. The parenchymatous organ in the depth of the defect is in both cases a hypoplastic lung.

Left picture: Operative findings in a newborn with RDS. On the left side in the picture, loops of small intestine and colon are visible, and on the right side in the picture a large defect in the depth of which some blood and a rudimental parenchymatous organ is recognizable. Right picture: Operative findings in a newborn with an RDS. On the left side some intestinal loops can be seen which have been pulled out of the thoracic cavity. In the depth of the triangular structure which is stretched by forceps a small opening is visible with an allusive parenchymatous organ.