CONGENITAL DEFICIENCY OF THE DIAPHRAGM

Recently there has been brought to the attention of the writer a case, encountered by Dr. C. W. Pollard in his practice, which presented the interesting and rather unusual condition of almost total deficiency of the left side of the diaphragm.Associated with and doubtless as a result of this, there were found some other minor anomalies, the most evident of which was a misplacement of some of the abdominal viscera into the left pleural cavity.It was obvious that these misplaced viscera represent a spurious hernia, due to an arrest in development of the left side of the diaphragm, rather than a true hernia due to a lack of diaphragmatic muscular tonus or development, for these viscera were not enclosed in a hernial sac but lay free in the left pleural cavity.On reviewing the available literature concerning the subject of congenital diaphragmatic hernia it was found that the spurious type occurs most frequently.References have been found in this literature to 127 cases which could definitely be classified as spurious, due to defective diaphragmatic formation.The greater percentage of these deficiencies were found to occur on the left side, seventeen only being right-sided and the remaining 110 left-sided.No authenticated cases of complete lack of the diaphragm were found, although one such case was mentioned as having occurred (Bowditch 1).In the case of deficiencies on the right side, they were, in prac¬ tically all cases, relatively small, admitting only a slight misplacement of abdominal viscera into the thorax, usually a small portion of the right lobe of the liver.In one case there was an extensive right- sided deficiency, which allowed the entire right lobe of the liver, all of the small intestine, the caecum and appendix, and the colon to pass into the right pleural cavity (Kocher2).Spencer3 also described a similar case in which there was a large defect on the right side of the dia¬ phragm, through which the right lobe of the liver, caecum and appendix, the small intestine, and the right kidney protruded into the right pleural cavity.St. Hiliare 4 gives an account of a case in which the right side of the diaphragm was lacking, admitting the stomach, small intestine, and the right lobe of the liver into the thorax.In seven of