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Surgery Unusual Hernias 9c7d4fca

False about bochdalek hernia is -

A
The defect is posterolateral
B
more common on right side
C
May lead to pulmonary hypoplasia and respiratory distress
D
Can be diagnosed prenataily
High-Yield Explanation
Ans. is 'b' i.e., More common on right side Congenital diaphragmatic herniao It is the herniation of abdominal contents into the thoracic cavity through the diaphragmatic defecto The defect may be# Posterolateral (Bochdalek hernia)# Retrosternal (Morgagni hernia)# At the esophageal hiatus (hiatal hernia)# Adjacent to the hiatus (paresophageal hernia)o Although all these defects are congenital, the term congenital diaphragmatic hernia is generally used for Bochdalek hernia.Bochdalek herniao Most Bochdalek hernia are on the left side (-80%) and may rarely be bilateral.o Compression of the lung results in pulmonary hypoplasia, involving both the lungs (ipsilateral > contralateral)o Pulmonary vasculature is also abnormal leading to pulmonary hypertension.o Thus the two main factors that affect morbidity and mortality are pulmonary hypoplasia and pulmonary hypertensiono The most frequent clinical presentation of CDH is respiratory distress due to severe hypoxemiao The anteroposterior diameter of the chest may be large along with a scaphoid abdomeno The diagnosis of CDH can be made prenatally by ultrasound.o The postnatal diagnosis is relatively straightforward because a plain chest radiograph demonstrates the gastric air bubbles or loops of bowel within the chest. There may also be a mediastinal shift away from the side of the hernia.o Historically, the surgical repair of a CDH was considered to be a surgical emergency because it was believed that the abdominal viscera within the chest prevented the ability to ventilate. More recently with the recognition of the role of pulmnary hypertension and pulmonary hypoplasia and the adverse effects of early operative repair on the pulmonary function has caused a policy of delayed repair. Thus most pediatric surgeons wait for a variable period (24 to 72 hrs) to allow for stabilization of the infant before doing surgical repair.

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