Much has been written on the subject of esophageal hiatus hernia without actually deriving a satisfactory explanation of what the lesions really are or why they should occur. A congenital basis for these hernias is generally accepted as playing an important role in their pathogenesis, although a clearly defined embryologic explanation seems to be lacking. It is the purpose of this study to point out the embryonic processes whose variants may be responsible for the formation of such hernias.
Many classifications of hiatus hernia suffer from an unnecessary complexity. Considering all hernias through the diaphragm, it is convenient and proper to divide them into traumatic and congenital, with the reservation that the latter group will have some acquired elements in their pathogenesis. This classification is one-sided, since the vast majority of diaphragmatic hernias are basically congenital; and it is of little clinical importance, since the identification of traumatic diaphragmatic hernia
KLEITSCH WP. Embryology of Congenital Diaphragmatic Hernia: I. Esophageal Hiatus Hernia. AMA Arch Surg. 1958;76(6):868–873. doi:10.1001/archsurg.1958.01280240026004
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