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Emergency Medicine251 papers

Diaphragmatic hernia

Last edited: 4/14/2026

Overview

Diaphragmatic hernia involves the protrusion of abdominal contents through a defect in the diaphragm, leading to potential respiratory and gastrointestinal complications. It can be congenital or acquired, with congenital cases often presenting in neonates and acquired cases typically resulting from trauma.

Diagnosis

  • Clinical Presentation: Symptoms vary by age and severity; neonates may present with respiratory distress, while adults might exhibit chest pain, dyspnea, or abdominal pain 1637.
  • Imaging: Chest and abdominal CT scans are crucial for diagnosis, delineating the extent of herniation and involvement of organs 16.
  • Physical Examination: Inspiratory increase in hernia size and decreased breath sounds on affected side can be indicative 6.

    • Management

  • Surgical Repair: Urgent surgical intervention is essential, often requiring thoracoabdominal or laparoscopic approaches depending on the complexity 1613.
  • Timing: Early surgical intervention is critical to prevent complications such as bowel obstruction or necrosis 17.
  • Mesh Use: Prosthetic mesh repair is recommended for definitive closure to reduce recurrence rates, especially in emergency settings 22.
  • Anesthesia Considerations: Tailored to patient frailty and condition; minimally invasive techniques benefit frail patients 4.

    • Special Populations

  • Pregnancy: Complicated cases require multidisciplinary management, often necessitating combined thoracic and abdominal approaches 13.
  • Pediatrics: Neonates with congenital diaphragmatic hernia often require staged surgical interventions and intensive care support 37.
  • Elderly: Frailty increases postoperative risks; minimally invasive techniques may offer advantages 4.
  • Comorbidities: Patients with comorbidities like obesity or respiratory issues require careful preoperative assessment and tailored surgical planning 19.

    • Key Recommendations

  • Urgent Surgical Intervention: Early surgical repair is crucial to prevent complications and improve outcomes 17 (Evidence: Strong).
  • Use of Prosthetic Mesh: Employ prosthetic mesh in emergency repairs to reduce recurrence rates 22 (Evidence: Moderate).
  • Consider Minimally Invasive Techniques: For frail patients, minimally invasive surgery can mitigate postoperative morbidity 4 (Evidence: Moderate).
  • Comprehensive Imaging: Utilize chest and abdominal imaging for accurate diagnosis and planning 16 (Evidence: Strong).
  • Multidisciplinary Care: For complex cases, especially in pregnancy, multidisciplinary teams enhance patient outcomes 13 (Evidence: Expert opinion).

    • References

    1 Thaventhiran A, Nazar N, Balasubramaniam D, Bailey C. Emergency obstructed hernia admissions over the COVID-19 national lockdowns: a regional review. Annals of the Royal College of Surgeons of England 2026. link 2 Isenberg EE, Sinamo J, Rubyan MA, Ehlers A, Telem DA. Recurrent emergent hernia repairs: who is at risk?. Surgical endoscopy 2025. link 3 Fredberg J, Oma E, Helgstrand F, Qvist N, Friis-Andersen H, Jørgensen LN. Emergency umbilical and epigastric hernia repair: nationwide registry-based study of long-term recurrence, mesh-related, and other complications. Surgical endoscopy 2025. link 4 Distler A, Salas Parra R, Huang X, Ahmed H, Barrera R, Patel V et al.. Minimally Invasive Surgery Benefits Frail Patients Undergoing Emergency Hernia Repairs. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2025. link 5 Almora JD, Faylona JMV. Emergent groin hernia repair in a tertiary government hospital in the Philippines: a 7-year review of case profiles, management practices, and post-operative outcomes. Hernia : the journal of hernias and abdominal wall surgery 2025. link 6 Mehra R, Chakrabarti R. Incidentally detected giant asymptomatic intercostal left lung hernia. BMJ case reports 2025. link 7 Brucchi F, Pelfini E, Masci E, Limongi C, Cassini D, Faillace G. Retrospective analysis of transabdominal preperitoneal hernia repair in emergency cases: A cohort study. World journal of surgery 2024. link 8 Jong DLC, Vries Reilingh TS, Hoek PEN, Zwaans WAR, Nienhuijs SW. Significant increase of emergency hernia operation during COVID. Hernia : the journal of hernias and abdominal wall surgery 2024. link 9 Huerta S. Letter re: Elective Hernia Repair in Obese Patients. The American surgeon 2023. link 10 Ali F, Sandblom G, Fathalla B, Wallin G. Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study. Hernia : the journal of hernias and abdominal wall surgery 2023. link 11 Slooter CD, Perquin CW, Zwaans WA, Roumen RM, Scheltinga MR, Slooter GD. Laparoscopic mesh removal for chronic postoperative inguinal pain following endoscopic hernia repair: a cohort study on the effect on pain. Hernia : the journal of hernias and abdominal wall surgery 2023. link 12 Villalonga A, Bento L, Lingombele T, Talaguma Bakwa JP. Anesthesia and surgery in very precarious conditions. Clinical cases. Revista espanola de anestesiologia y reanimacion 2022. link 13 Alvarez Padilla FN, Brosutti OD. Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia. Medicina 2021. link 14 Heylen J, Campioni-Norman D, Lowcock D, Varatharajan L, Kostalas M, Irukulla M et al.. Inguinoscrotal hernias containing stomach: risk of emergency presentation. Annals of the Royal College of Surgeons of England 2021. link 15 Russell TB, Elberm H. Emergency hernia surgery at a high-volume tertiary centre: a 3-year experience. ANZ journal of surgery 2021. link 16 Perrone G, Giuffrida M, Annicchiarico A, Bonati E, Del Rio P, Testini M et al.. Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. World journal of surgery 2020. link 17 Leeds IL, Jones C, DiBrito SR, Sakran JV, Haut ER, Kent AJ. Delay in emergency hernia surgery is associated with worse outcomes. Surgical endoscopy 2020. link 18 Pilon RN, Desai SP. Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report. Journal of anesthesia history 2020. link 19 Nunez MF, Ortega G, Souza Mota LG, Olufajo OA, Altema DW, Fullum TM et al.. Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States. American journal of surgery 2019. link 20 Leake PA, Toppin P, Reid M, Plummer J, Roberts P, Harding-Goldson H et al.. Improving patient outcomes with inguinal hernioplasty-local anaesthesia versus local anaesthesia and conscious sedation: a randomized controlled trial. Hernia : the journal of hernias and abdominal wall surgery 2019. link 21 Ioannidis A, Karanikas I, Koutserimpas C, Velimezis G. Combined Littre and Richter's femoral hernia: an extremely rare intra-operative finding. Il Giornale di chirurgia 2018. link 22 Duan SJ, Qiu SB, Ding NY, Liu HS, Zhang NS, Wei YT. Prosthetic Mesh Repair in the Emergency Management of Acutely Strangulated Groin Hernias with Grade I Bowel Necrosis: A Rational Choice. The American surgeon 2018. link 23 Moxen D. Compassion in continence care. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2017. link 24 Balsara ZR, Martin AE, Wiener JS, Routh JC, Ross SS. Congenital spigelian hernia and ipsilateral cryptorchidism: raising awareness among urologists. Urology 2014. link 25 Quek KH, Phua DS. Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair. Singapore medical journal 2014. link 26 Silins V, Julien F, Brasher C, Nivoche Y, Mantz J, Dahmani S. Predictive factors of PACU stay after herniorraphy in infant: a classification and regression tree analysis. Paediatric anaesthesia 2012. link 27 Grosse Frie K, van der Meulen J, Black N. Single item on patients' satisfaction with condition provided additional insight into impact of surgery. Journal of clinical epidemiology 2012. link 28 Hoelzle M, Weiss M, Dillier C, Gerber A. Comparison of awake spinal with awake caudal anesthesia in preterm and ex-preterm infants for herniotomy. Paediatric anaesthesia 2010. link 29 Chaar CI, Attanasio P, Detterbeck F. Disruption of the costal margin with transdiaphragmatic abdominal herniation induced by coughing. The American surgeon 2008. link 30 Deysine M. Postmesh herniorrhaphy wound infections: can they be eliminated?. International surgery 2005. link 31 Kugel RD. The Kugel repair for groin hernias. The Surgical clinics of North America 2003. link00123-3) 32 Chassaing N, Lacombe D, Carles D, Calvas P, Saura R, Bieth E. Donnai-Barrow syndrome: four additional patients. American journal of medical genetics. Part A 2003. link 33 McFarlane ME. Analgesia-sedation for day-case inguinal hernia repair. A review of patient acceptance and morbidity. The West Indian medical journal 2000. link 34 Rodefeld MD, Soper NJ. Parahiatal hernia with volvulus and incarceration: laparoscopic repair of a rare defect. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 1998. link80012-7) 35 Ciampolini J, Boyce DE, Shandall AA. Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England. Annals of the Royal College of Surgeons of England 1998. link 36 Raab SS. The cost-effectiveness of routine histologic examination. American journal of clinical pathology 1998. link 37 Gripp KW, Donnai D, Clericuzio CL, McDonald-McGinn DM, Guttenberg M, Zackai EH. Diaphragmatic hernia-exomphalos-hypertelorism syndrome: a new case and further evidence of autosomal recessive inheritance. American journal of medical genetics 1997. link1096-8628(19970211)68:4<441::aid-ajmg13>3.0.co;2-s) 38 Ritschel S, Heimbach D, Schoeneich G. Ureterosciatic hernia. Scandinavian journal of urology and nephrology 1996. link 39 Ghanchi FD, Patel KR. Herniation of lung. The Indian journal of chest diseases & allied sciences 1996. link 40 Devriendt K, Deloof E, Moerman P, Legius E, Vanhole C, de Zegher F et al.. Diaphragmatic hernia in Denys-Drash syndrome. American journal of medical genetics 1995. link 41 Ding Y, White PF. Post-herniorrhaphy pain in outpatients after pre-incision ilioinguinal-hypogastric nerve block during monitored anaesthesia care. Canadian journal of anaesthesia = Journal canadien d'anesthesie 1995. link 42 Chan MY, Ng BK. Intrahernial tumour--a case report. Singapore medical journal 1994. link 43 Rayter Z, Chinegwundoh F. An unusual omental hernia. Postgraduate medical journal 1990. link 44 Cloud DT. Major ambulatory surgery of the pediatric patient. The Surgical clinics of North America 1987. link44286-6) 45 Hooper TL, Lawson RA. Volvulus of the stomach--an unusual cause of pulsus paradoxus. Postgraduate medical journal 1986. link 46 Crow S, Greene VW. Aseptic transgressions among surgeons and anesthesiologists: a quantitative study. Archives of surgery (Chicago, Ill. : 1960) 1982. link 47 Berardi RS. Paraduodenal hernias. Surgery, gynecology & obstetrics 1981. link 48 Sugarbaker PH. Prosthetic mesh repair of large hernias at the site of colonic stomas. Surgery, gynecology & obstetrics 1980. link 49 Goulbourne IA, Ruckley CV. Operations for hernia and varicose veins in a day-bed unit. British medical journal 1979. link 50 Garraway WM, Cuthbertson C, Fenwick N, Ruckley CV, Prescott RJ. Consumer acceptability of day care after operations for hernia or varicose veins. Journal of epidemiology and community health 1978. link 51 Prescott RJ, Cutherbertson C, Fenwick N, Garraway WM, Ruckley CV. Economic aspects of day care after operations for hernia or varicose veins. Journal of epidemiology and community health 1978. link 52 Ruckley CV, Cuthbertson C, Fenwick N, Prescott RJ, Garraway WM. Day care after operations for hernia or varicose veins: a controlled trial. The British journal of surgery 1978. link 53 Alexander MS. Hernia through the foramen of Winslow. The Australian and New Zealand journal of surgery 1976. link

    Original source

    1. [1]
      Emergency obstructed hernia admissions over the COVID-19 national lockdowns: a regional review. — Thaventhiran A, Nazar N, Balasubramaniam D, Bailey C Annals of the Royal College of Surgeons of England (2026)
    2. [2]
      Recurrent emergent hernia repairs: who is at risk? — Isenberg EE, Sinamo J, Rubyan MA, Ehlers A, Telem DA Surgical endoscopy (2025)
    3. [3]
      Emergency umbilical and epigastric hernia repair: nationwide registry-based study of long-term recurrence, mesh-related, and other complications. — Fredberg J, Oma E, Helgstrand F, Qvist N, Friis-Andersen H, Jørgensen LN Surgical endoscopy (2025)
    4. [4]
      Minimally Invasive Surgery Benefits Frail Patients Undergoing Emergency Hernia Repairs. — Distler A, Salas Parra R, Huang X, Ahmed H, Barrera R, Patel V et al. JSLS : Journal of the Society of Laparoendoscopic Surgeons (2025)
    5. [5]
      Emergent groin hernia repair in a tertiary government hospital in the Philippines: a 7-year review of case profiles, management practices, and post-operative outcomes. — Almora JD, Faylona JMV Hernia : the journal of hernias and abdominal wall surgery (2025)
    6. [6]
      Incidentally detected giant asymptomatic intercostal left lung hernia. — Mehra R, Chakrabarti R BMJ case reports (2025)
    7. [7]
      Retrospective analysis of transabdominal preperitoneal hernia repair in emergency cases: A cohort study. — Brucchi F, Pelfini E, Masci E, Limongi C, Cassini D, Faillace G World journal of surgery (2024)
    8. [8]
      Significant increase of emergency hernia operation during COVID. — Jong DLC, Vries Reilingh TS, Hoek PEN, Zwaans WAR, Nienhuijs SW Hernia : the journal of hernias and abdominal wall surgery (2024)
    9. [9]
      Letter re: Elective Hernia Repair in Obese Patients. — Huerta S The American surgeon (2023)
    10. [10]
      Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study. — Ali F, Sandblom G, Fathalla B, Wallin G Hernia : the journal of hernias and abdominal wall surgery (2023)
    11. [11]
      Laparoscopic mesh removal for chronic postoperative inguinal pain following endoscopic hernia repair: a cohort study on the effect on pain. — Slooter CD, Perquin CW, Zwaans WA, Roumen RM, Scheltinga MR, Slooter GD Hernia : the journal of hernias and abdominal wall surgery (2023)
    12. [12]
      Anesthesia and surgery in very precarious conditions. Clinical cases. — Villalonga A, Bento L, Lingombele T, Talaguma Bakwa JP Revista espanola de anestesiologia y reanimacion (2022)
    13. [13]
      Benefit of video-assisted thoracic surgery in the emergency of a complicated postpartum diaphragmatic hernia. — Alvarez Padilla FN, Brosutti OD Medicina (2021)
    14. [14]
      Inguinoscrotal hernias containing stomach: risk of emergency presentation. — Heylen J, Campioni-Norman D, Lowcock D, Varatharajan L, Kostalas M, Irukulla M et al. Annals of the Royal College of Surgeons of England (2021)
    15. [15]
      Emergency hernia surgery at a high-volume tertiary centre: a 3-year experience. — Russell TB, Elberm H ANZ journal of surgery (2021)
    16. [16]
      Complicated Diaphragmatic Hernia in Emergency Surgery: Systematic Review of the Literature. — Perrone G, Giuffrida M, Annicchiarico A, Bonati E, Del Rio P, Testini M et al. World journal of surgery (2020)
    17. [17]
      Delay in emergency hernia surgery is associated with worse outcomes. — Leeds IL, Jones C, DiBrito SR, Sakran JV, Haut ER, Kent AJ Surgical endoscopy (2020)
    18. [18]
      Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report. — Pilon RN, Desai SP Journal of anesthesia history (2020)
    19. [19]
      Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States. — Nunez MF, Ortega G, Souza Mota LG, Olufajo OA, Altema DW, Fullum TM et al. American journal of surgery (2019)
    20. [20]
      Improving patient outcomes with inguinal hernioplasty-local anaesthesia versus local anaesthesia and conscious sedation: a randomized controlled trial. — Leake PA, Toppin P, Reid M, Plummer J, Roberts P, Harding-Goldson H et al. Hernia : the journal of hernias and abdominal wall surgery (2019)
    21. [21]
      Combined Littre and Richter's femoral hernia: an extremely rare intra-operative finding. — Ioannidis A, Karanikas I, Koutserimpas C, Velimezis G Il Giornale di chirurgia (2018)
    22. [22]
      Prosthetic Mesh Repair in the Emergency Management of Acutely Strangulated Groin Hernias with Grade I Bowel Necrosis: A Rational Choice. — Duan SJ, Qiu SB, Ding NY, Liu HS, Zhang NS, Wei YT The American surgeon (2018)
    23. [23]
      Compassion in continence care. — Moxen D Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2017)
    24. [24]
      Congenital spigelian hernia and ipsilateral cryptorchidism: raising awareness among urologists. — Balsara ZR, Martin AE, Wiener JS, Routh JC, Ross SS Urology (2014)
    25. [25]
      Bilateral rectus sheath blocks as the single anaesthetic technique for an open infraumbilical hernia repair. — Quek KH, Phua DS Singapore medical journal (2014)
    26. [26]
      Predictive factors of PACU stay after herniorraphy in infant: a classification and regression tree analysis. — Silins V, Julien F, Brasher C, Nivoche Y, Mantz J, Dahmani S Paediatric anaesthesia (2012)
    27. [27]
      Single item on patients' satisfaction with condition provided additional insight into impact of surgery. — Grosse Frie K, van der Meulen J, Black N Journal of clinical epidemiology (2012)
    28. [28]
      Comparison of awake spinal with awake caudal anesthesia in preterm and ex-preterm infants for herniotomy. — Hoelzle M, Weiss M, Dillier C, Gerber A Paediatric anaesthesia (2010)
    29. [29]
      Disruption of the costal margin with transdiaphragmatic abdominal herniation induced by coughing. — Chaar CI, Attanasio P, Detterbeck F The American surgeon (2008)
    30. [30]
      Postmesh herniorrhaphy wound infections: can they be eliminated? — Deysine M International surgery (2005)
    31. [31]
      The Kugel repair for groin hernias. — Kugel RD The Surgical clinics of North America (2003)
    32. [32]
      Donnai-Barrow syndrome: four additional patients. — Chassaing N, Lacombe D, Carles D, Calvas P, Saura R, Bieth E American journal of medical genetics. Part A (2003)
    33. [33]
      Analgesia-sedation for day-case inguinal hernia repair. A review of patient acceptance and morbidity. — McFarlane ME The West Indian medical journal (2000)
    34. [34]
      Parahiatal hernia with volvulus and incarceration: laparoscopic repair of a rare defect. — Rodefeld MD, Soper NJ Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (1998)
    35. [35]
      Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England. — Ciampolini J, Boyce DE, Shandall AA Annals of the Royal College of Surgeons of England (1998)
    36. [36]
      The cost-effectiveness of routine histologic examination. — Raab SS American journal of clinical pathology (1998)
    37. [37]
      Diaphragmatic hernia-exomphalos-hypertelorism syndrome: a new case and further evidence of autosomal recessive inheritance. — Gripp KW, Donnai D, Clericuzio CL, McDonald-McGinn DM, Guttenberg M, Zackai EH American journal of medical genetics (1997)
    38. [38]
      Ureterosciatic hernia. — Ritschel S, Heimbach D, Schoeneich G Scandinavian journal of urology and nephrology (1996)
    39. [39]
      Herniation of lung. — Ghanchi FD, Patel KR The Indian journal of chest diseases & allied sciences (1996)
    40. [40]
      Diaphragmatic hernia in Denys-Drash syndrome. — Devriendt K, Deloof E, Moerman P, Legius E, Vanhole C, de Zegher F et al. American journal of medical genetics (1995)
    41. [41]
      Post-herniorrhaphy pain in outpatients after pre-incision ilioinguinal-hypogastric nerve block during monitored anaesthesia care. — Ding Y, White PF Canadian journal of anaesthesia = Journal canadien d'anesthesie (1995)
    42. [42]
      Intrahernial tumour--a case report. — Chan MY, Ng BK Singapore medical journal (1994)
    43. [43]
      An unusual omental hernia. — Rayter Z, Chinegwundoh F Postgraduate medical journal (1990)
    44. [44]
      Major ambulatory surgery of the pediatric patient. — Cloud DT The Surgical clinics of North America (1987)
    45. [45]
      Volvulus of the stomach--an unusual cause of pulsus paradoxus. — Hooper TL, Lawson RA Postgraduate medical journal (1986)
    46. [46]
      Aseptic transgressions among surgeons and anesthesiologists: a quantitative study. — Crow S, Greene VW Archives of surgery (Chicago, Ill. : 1960) (1982)
    47. [47]
      Paraduodenal hernias. — Berardi RS Surgery, gynecology & obstetrics (1981)
    48. [48]
      Prosthetic mesh repair of large hernias at the site of colonic stomas. — Sugarbaker PH Surgery, gynecology & obstetrics (1980)
    49. [49]
      Operations for hernia and varicose veins in a day-bed unit. — Goulbourne IA, Ruckley CV British medical journal (1979)
    50. [50]
      Consumer acceptability of day care after operations for hernia or varicose veins. — Garraway WM, Cuthbertson C, Fenwick N, Ruckley CV, Prescott RJ Journal of epidemiology and community health (1978)
    51. [51]
      Economic aspects of day care after operations for hernia or varicose veins. — Prescott RJ, Cutherbertson C, Fenwick N, Garraway WM, Ruckley CV Journal of epidemiology and community health (1978)
    52. [52]
      Day care after operations for hernia or varicose veins: a controlled trial. — Ruckley CV, Cuthbertson C, Fenwick N, Prescott RJ, Garraway WM The British journal of surgery (1978)
    53. [53]
      Hernia through the foramen of Winslow. — Alexander MS The Australian and New Zealand journal of surgery (1976)
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