A Right-sided True Diaphragmatic Hernia with Unusual Features.

Congenital diaphragmatic hernia is a rare and grave condition. It is well known as a cause of still-birth and neonatal death. Of 127 cases reviewed by J. S. Latta' the age was given in 112 cases and of these 88 were either stillborn or died within a few hours of birth. In a series of 57 cases collected by Funck Brentano2 51 cases were either still-born or died within 24 hours of birth. The term diaphragmatic hernia is applied to anyprotrusionof the abdominal contents through the diaphragm. In a majority of the cases the abdominal contents pass through an opening in the diaphragm not constituting a hernia in the true sense of the word but a spurious diaphragmatic hernia. The true diaphragmatic hernia projects into the pleural cavity through a space in the muscle covered by peritoneum and pleura. Among 80 cases of congenital hernia collected by Bohn3 a hernial sac was present in only 14. The left side is more frequently affected than the right. Of 42 cases of diaphragmatic hernia according to Popp4, 37 were on the left side and only 5 on the right. Of Latta's 127 cases only 17 were on the right side. Further, when the right side is affected the hernia is usually small. Spencer5 records two cases of large right-sided diaphragmatic hernia. According to Ballantyne6 the male sex seems to be more liable to diaphragmatic hernia than the female; thus in 67 case records examined by him 47 were males and 20 females. Only occasionally is the diaphragmatic defect accompanied by other developmental defects, except that of an undeveloped lung, and in practically all cases the child is normal in external appearance. The following case is recorded not only on account of the rarity of the large right-sided true diaphragmatic hernia, but also because of the associated mal-development of suprarenal gland and secondary herniation of the primary sac.