WHY BMV CONTRAINDICATED IN DIAPHRAGMATIC HERNIA

Table of contents :

1. What is Diaphragmatic Hernia?
2. Causes of Diaphragmatic Hernia.
3. Signs and Symptoms of Diaphragmatic Hernia.
4. Complications of Diaphragmatic Hernia.
5. What is BMV?
6. Procedure of BMV.
7. Uses of BMV.
8. Why BMV Contraindicated in Diaphragmatic Hernia?
9. Risk of Incarceration.
10. Risk of Strangulation.
11. Risk of Perforation.
12. Management of Diaphragmatic Hernia
13. Non-surgical management.
14. Surgical management.
15. Conclusion

What is Diaphragmatic Hernia?

A diaphragmatic hernia occurs when an opening in the diaphragm allows abdominal organs to move into the chest cavity. The diaphragm is a thin muscle separating the chest and abdominal cavities. It plays a vital role during breathing and helps maintain proper pressure in the chest and abdomen. When a portion of the diaphragm weakens or tears, organs like the stomach, intestines, and spleen can push through this opening, leading to a diaphragmatic hernia.

Causes of Diaphragmatic Hernia

There are several causes of diaphragmatic hernia, including:

Congenital defects: Some individuals are born with weakened or incompletely formed diaphragms, predisposing them to hernias.

Traumatic injuries: Blunt or penetrating trauma to the abdomen can cause tears in the diaphragm, resulting in a hernia.

Increased abdominal pressure: Chronic conditions that increase abdominal pressure, such as obesity, pregnancy, or severe coughing, can weaken the diaphragm and lead to a hernia.

Aging: As we age, the diaphragm naturally weakens, making it more susceptible to herniation.

Signs and Symptoms of Diaphragmatic Hernia

Symptoms of a diaphragmatic hernia can vary depending on the size and location of the defect. Some common signs and symptoms include:

Heartburn and indigestion: The stomach’s upward displacement can cause acid reflux and heartburn.

Shortness of breath: The herniated organs can press on the lungs, making it difficult to breathe.

Chest pain: Pressure or pain in the chest is often experienced.

Abdominal pain: Discomfort in the abdomen may occur due to the abnormal positioning of organs.

Nausea and vomiting: The stomach’s inability to function correctly can lead to these symptoms.

Complications of Diaphragmatic Hernia

If left untreated, a diaphragmatic hernia can lead to serious complications, including:

Incarceration: The herniated organs can become trapped within the opening in the diaphragm, leading to obstruction of the bowels or other complications.

Strangulation: When the blood supply to the herniated organs is cut off, strangulation occurs, requiring emergency surgery to prevent tissue death.

Perforation: The herniated organs can become perforated, leading to leakage of stomach contents or bowel contents into the chest cavity.

What is BMV?

BMV (Bartholin's Mucous Cyst Marsupialization) is a surgical procedure performed to treat Bartholin's cysts, which are fluid-filled sacs that develop in the Bartholin's glands located on either side of the vaginal opening.

Procedure of BMV

The BMV procedure involves making an incision into the cyst, draining the fluid, and then suturing the edges of the cyst wall to the surrounding tissue. This allows the cyst to drain and prevents it from refilling.

Uses of BMV

BMV is commonly performed to treat Bartholin's cysts that are causing discomfort, pain, or infection. It is also used to prevent recurrent Bartholin's cysts from forming.

Why BMV Contraindicated in Diaphragmatic Hernia?

BMV is contraindicated in patients with diaphragmatic hernia because of the increased risk of serious complications. The presence of a diaphragmatic hernia creates an abnormal communication between the chest and abdominal cavities, allowing abdominal contents to enter the chest. Performing BMV in such a patient carries significant risks, including:

Risk of Incarceration

During BMV, manipulating the tissues in the groin area can inadvertently push abdominal contents further into the chest cavity, increasing the risk of incarceration. Incarceration occurs when the herniated organs become trapped in the opening, leading to obstruction of the bowels or other complications.

Risk of Strangulation

The increased pressure and manipulation during BMV can potentially compromise the blood supply to the herniated organs, leading to strangulation. Strangulation is a serious condition that requires emergency surgery to prevent tissue death.

Risk of Perforation

The delicate nature of the diaphragm and the surrounding tissues makes them susceptible to perforation during BMV. Perforation can lead to leakage of stomach contents or bowel contents into the chest cavity, causing infection and other complications.

Management of Diaphragmatic Hernia

The management of diaphragmatic hernia depends on the size and location of the defect, as well as the patient's symptoms.

Non-surgical management

For small hernias that are not causing symptoms, non-surgical management may be appropriate. This may include lifestyle modifications, such as maintaining a healthy weight and avoiding activities that increase abdominal pressure.

Surgical management

Surgical intervention is necessary for larger hernias or those causing symptoms. The surgical approach depends on the specific circumstances and may involve open surgery or laparoscopic surgery.

Conclusion

BMV is a surgical procedure commonly used to treat Bartholin's cysts. However, it is contraindicated in patients with diaphragmatic hernia due to the increased risk of serious complications, including incarceration, strangulation, and perforation. The management of diaphragmatic hernia depends on the individual patient's situation and may involve non-surgical or surgical approaches.

Frequently Asked Questions

1. What is the most common cause of diaphragmatic hernia?

Congenital defects are the most common cause of diaphragmatic hernia, often present from birth.

2. What are the symptoms of a diaphragmatic hernia?

Common symptoms include heartburn, shortness of breath, chest pain, abdominal pain, nausea, and vomiting.

3. What are the complications of a diaphragmatic hernia?

Complications may include incarceration, strangulation, and perforation.

4. Why is BMV contraindicated in diaphragmatic hernia?

BMV is contraindicated due to the increased risk of incarceration, strangulation, and perforation in patients with diaphragmatic hernia.

5. How is a diaphragmatic hernia managed?

Management depends on the size, location, and symptoms of the hernia. Non-surgical management may be appropriate for small, asymptomatic hernias, while surgical intervention is necessary for larger or symptomatic hernias.