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Zugayar D, Berkovits R, Tenenbaum A, Erez E, Arbell D, Koplewitz BZ. Post-operative anterior diaphragmatic hernias in children with Trisomy 21 after cardiac surgery. Eur J Pediatr 2023; 182:4529-4535. [PMID: 37507598 DOI: 10.1007/s00431-023-05127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Morgagni hernias account for less than 5% of congenital diaphragmatic hernias. They are characteristically retrosternal and bilateral, with right-sided predominance. An association between Trisomy 21 and diaphragmatic hernias resembling Morgagni hernia has been reported, but the effect of cardiac surgery on its formation has not been investigated. The purpose of this study was to determine whether there is a higher incidence of anterior diaphragmatic hernias in children with Trisomy 21 after cardiac surgery. We compared the prevalence of anterior diaphragmatic hernias in 92 patients with Trisomy 21 who underwent cardiac surgery with its prevalence in 100 children without Trisomy 21 who underwent cardiac surgery. All available CXRs of all children underwent revision for the presence of an anterior diaphragmatic hernia by a pediatric radiologist. Within the study group, four cases of an anterior diaphragmatic hernia were detected, all upon presentation to the emergency room due to breathing difficulties. No cases of an anterior diaphragmatic hernia were found in the control group (P = 0.0094). CONCLUSIONS A high index of suspicion for an anterior diaphragmatic hernia should be maintained in children with Trisomy 21 who have undergone cardiac surgery and present with breathing difficulty. If CXR findings are uncertain, UGI series and\or CT should be performed. In light of our findings, the surgical technique has been modified in patients with DS in our medical center. WHAT IS KNOWN • Several studies reported an association between Trisomy 21 and diaphragmatic hernia resembling Morgagni hernia, but the effect of cardiac surgery on its formation has not been investigated. WHAT IS NEW • There is a higher incidence of anterior diaphragmatic hernia resembling a Morgagni hernia in children with Trisomy 21 after cardiac surgery. • A high index of suspicion for an anterior diaphragmatic hernia should be maintained in children with Trisomy 21 who have undergone cardiac surgery and present with breathing difficulty. If CXR findings are uncertain, UGI series and\or CT should be performed.
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Affiliation(s)
- Diaa Zugayar
- Departments of Pediatric Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Reuven Berkovits
- Departments of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | - Ariel Tenenbaum
- Departments of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Eldad Erez
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Departments of Cardiac and Chest Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Dan Arbell
- Departments of Pediatric Surgery, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Benjamin Z Koplewitz
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.
- Departments of Diagnostic Imaging, Hadassah Medical Center, Hebrew University, POB 12000, 91000, Jerusalem, Israel.
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Alrashidi AS, Amawi MA, Alanazi NO, Aljohani DA, Alanazi GA, Alatawi MM. Morgagni Hernia in Down Syndrome: A Case Report. Cureus 2023; 15:e48019. [PMID: 38034278 PMCID: PMC10687593 DOI: 10.7759/cureus.48019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Morgagni hernia is a rare form of congenital diaphragmatic hernia. It is associated with other congenital abnormalities. Its association with Down syndrome has been reported in the literature. While pediatric patients usually present with respiratory manifestations, the clinical presentation of Morgagni hernia is non-specific. Therefore, Morgagni hernia is mainly diagnosed by radiological imaging. The rarity of this type of hernia along with the vague clinical presentation can lead to missed diagnosis. Here, we report the case of a Down syndrome patient with an acute onset of shortness of breath. She was diagnosed with Morgagni hernia by computed tomography. Morgagni hernia should be considered in the differential diagnosis of Down syndrome patients presenting with respiratory distress.
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Affiliation(s)
| | - Muhanned A Amawi
- Pediatrics Department, King Salman Armed Forces Hospital, Tabuk, SAU
| | - Nouf O Alanazi
- Pediatrics Department, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | - Dina A Aljohani
- Pediatrics Department, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | - Ghadah A Alanazi
- Pediatrics Department, Faculty of Medicine, University of Tabuk, Tabuk, SAU
| | - Manal M Alatawi
- Pediatrics Department, Faculty of Medicine, University of Tabuk, Tabuk, SAU
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Adereti C, Zahir J, Robinson E, Pursel J, Hamdallah I. A Case Report and Literature Review on Incidental Morgagni Hernia in Bariatric Patients: To Repair or Not to Repair? Cureus 2023; 15:e39950. [PMID: 37416052 PMCID: PMC10319596 DOI: 10.7759/cureus.39950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Morgagni hernia (MH) is a congenital diaphragmatic hernia that is often asymptomatic in adult patients. These defects may be discovered incidentally during the intraoperative period and repaired laparoscopically with tension-free synthetic mesh when surgery is warranted. Presently, there is a dearth of studies addressing incidental MH repair in the setting of concomitant bariatric surgery. As such, there are no clear guidelines as to whether or not asymptomatic hernias found incidentally during bariatric surgery require operative repair. Herein, we present the case of a morbidly obese female patient with an incidental Morgagni defect that was identified during an elective sleeve gastrectomy. We also reviewed the literature to assess the efficacy of concurrent bariatric surgery and hernia repair.
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Affiliation(s)
| | - Jamal Zahir
- Medicine, Ross University School of Medicine, Miramar, USA
| | | | | | - Isam Hamdallah
- Bariatric Surgery, Ascension Saint Agnes, Baltimore, USA
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Daifoladi AA, Talemi HG, Rezaei MA, Wardak AF, Negin F, Mousavi SH. Concomitant trans-sternal repair of Morgagni hernia and ventricular septal defect in a patient with Down syndrome: A case report. Int J Surg Case Rep 2022; 92:106911. [PMID: 35245851 PMCID: PMC8892097 DOI: 10.1016/j.ijscr.2022.106911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Morgagni hernia is a rare type of hernia occurring secondary to potential anterior-medial defects in the diaphragm. The association of the defect with congenital cardiac pathologies and Down syndrome are well known. The defect is repaired usually by trans-abdominal or transthoracic approaches. Trans-sternal repair of the hernia is preferred in patients undergoing concomitant open heart surgery. CASE PRESENTATION A 2-year-old child with Down syndrome underwent concomitant repair of Morgagni hernia and closure of his ventricular septal defect under cardiopulmonary bypass. The hernia was corrected by the sternotomy approach, without opening the hernia content, before the correction of the cardiac pathology. The patient made an uneventful recovery and was discharged on the 4th postoperative day. DISCUSSION Preoperative diagnosis of diaphragmatic hernia in congenital heart disease is important to decrease mortality rate. However, trans-sternal exposure of the defect is also possible, as in this case, in patients undergoing open heart surgery for congenital cardiac defects. The defect can be repaired by this approach, concomitantly with the cardiac anomaly, no need for an additional incision and without opening the hernia sac. CONCLUSION Our experience, although very limited, in patients who are suffering from Morgagni hernia and concomitant congenital heart defects shows that simultaneous repair of Morgagni hernia through midline sternotomy prior to cardiac procedure is effective. As Morgagni hernia can be accompanied with many congenital cardiac anomalies, cardiac surgeons should be familiar with the trans-sternal approach to the defect.
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Affiliation(s)
| | | | | | | | - Fawzia Negin
- Faculty of Medicine, Balkh University, Balkh, Afghanistan
| | - Sayed Hamid Mousavi
- Medical Research Center, Kateb University, Kabul, Afghanistan; Afghanistan National Charity Organization for Special Diseases (ANCOSD), Kabul 1007, Afghanistan.
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Okur MH, Aydogdu B, Azizoglu M, Arslan S, Basuguy E. A novel scarless laparoscopic method for morgagni hernia repair. Niger J Clin Pract 2022; 25:1517-1522. [DOI: 10.4103/njcp.njcp_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cannata G, Caporilli C, Grassi F, Perrone S, Esposito S. Management of Congenital Diaphragmatic Hernia (CDH): Role of Molecular Genetics. Int J Mol Sci 2021; 22:ijms22126353. [PMID: 34198563 PMCID: PMC8231903 DOI: 10.3390/ijms22126353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a relatively common major life-threatening birth defect that results in significant mortality and morbidity depending primarily on lung hypoplasia, persistent pulmonary hypertension, and cardiac dysfunction. Despite its clinical relevance, CDH multifactorial etiology is still not completely understood. We reviewed current knowledge on normal diaphragm development and summarized genetic mutations and related pathways as well as cellular mechanisms involved in CDH. Our literature analysis showed that the discovery of harmful de novo variants in the fetus could constitute an important tool for the medical team during pregnancy, counselling, and childbirth. A better insight into the mechanisms regulating diaphragm development and genetic causes leading to CDH appeared essential to the development of new therapeutic strategies and evidence-based genetic counselling to parents. Integrated sequencing, development, and bioinformatics strategies could direct future functional studies on CDH; could be applied to cohorts and consortia for CDH and other birth defects; and could pave the way for potential therapies by providing molecular targets for drug discovery.
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Affiliation(s)
- Giulia Cannata
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.C.); (C.C.); (F.G.)
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.C.); (C.C.); (F.G.)
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.C.); (C.C.); (F.G.)
| | - Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.C.); (C.C.); (F.G.)
- Correspondence: ; Tel.: +39-0521-7047
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Köroğlu FT, Yılmaz L, Keskin A. Coexistence of Down Syndrome and Congenital Diaphragmatic Hernia: A Case Report. Ankara Medical Journal 2018. [DOI: 10.17098/amj.497508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Tan YW, Banerjee D, Cross KM, De Coppi P, Blackburn SC, Rees CM, Giuliani S, Curry JI, Eaton S. Morgagni hernia repair in children over two decades: Institutional experience, systematic review, and meta-analysis of 296 patients. J Pediatr Surg 2018; 53:1883-1889. [PMID: 29776739 DOI: 10.1016/j.jpedsurg.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch. METHODS We retrospectively reviewed all cases of MH who underwent first-time repair in 2012-2017 in our institution to determine recurrence and complication rate. A MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH was conducted for systematic review. Eligible articles published from 1997-2017 with follow-up data available were included. Primary outcomes measured were recurrence and complication. Meta-analysis to compare open versus MIS and primary versus patch repair in the MIS group were performed in comparative cohorts. Continuous data were presented as median (range), and statistical significance was P<0.05. RESULTS In our institution, 12 consecutive patients aged 17-month-old (22 days-7 years), underwent laparoscopic patch repair of MH, with one conversion to laparotomy. No recurrence or significant complication occurred over a follow-up period of 8 months (1-48 months). Thirty-six articles were included from literature review and were combined with the current series. All were retrospective case reports or series, of which 6 were comparative cohorts with both MIS and open repairs. A total of 296 patients from 37 series were ultimately used for analysis: 80 had open repair (4 patch) and 216 had MIS repair (32 patch), with a patch rate of 12%. There were 13 recurrences (4%): no difference between open and MIS repairs (4/80 vs 9/216, p=0.75); recurrence rate following primary repair was 13/260 (5%), but no recurrence occurred with 36 patch repairs. Meta-analysis showed no difference in recurrence between open and MIS repair (p=0.83), whereas patch repair was associated with 14% less recurrence compared with primary repair, although it did not reach statistical significance (p=0.12). There were 13 complications (5%): no difference between open and MIS repairs (5/80 vs 8/216, p=0.35). One small bowel obstruction occurred in a patient who had laparoscopic patch repair. CONCLUSION In MH, recurrence and complication rates are comparable between MIS and open repairs. Use of patch appeared to confer additional benefit in reducing recurrence. TYPE OF STUDY Systematic review LEVEL OF EVIDENCE: 3A.
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Affiliation(s)
- Yew-Wei Tan
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Debasish Banerjee
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK; Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK.
| | | | - Simon C Blackburn
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Clare M Rees
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Joe I Curry
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Simon Eaton
- Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK
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9
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Al-salem AH. Congenital Morgagni’s hernia in infants and children. Annals of Pediatric Surgery 2017; 13:182-187. [DOI: 10.1097/01.xps.0000516210.28462.2d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Esposito C, Escolino M, Varlet F, Saxena A, Irtan S, Philippe P, Settimi A, Cerulo M, Till H, Becmeur F, Holcomb GW. Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients. Surg Endosc 2016; 31:3320-3325. [DOI: 10.1007/s00464-016-5365-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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11
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Chen CP, Wang YL, Chern SR, Liu YP, Peng CR, Kuo YL, Wu PS, Chen WL, Wang W. Prenatal diagnosis and array comparative genomic hybridization characterization of trisomy 21 in a fetus associated with right congenital diaphragmatic hernia and a review of the literature of chromosomal abnormalities associated with congenital diaphragmatic hernia. Taiwan J Obstet Gynecol 2015; 54:66-70. [PMID: 25675923 DOI: 10.1016/j.tjog.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Rapid genome-wide aneuploidy diagnosis using uncultured amniocytes and array comparative genomic hybridization (aCGH) is useful in pregnancy with abnormal ultrasound findings. The purpose of this report is to report a case of right congenital diaphragmatic hernia (CDH) associated with trisomy 21 diagnosed prenatally by aCGH and to review the literature of chromosomal abnormalities associated with CDH. CASE REPORT A 29-year-old woman was referred for genetic counseling at 25 weeks of gestation because of fetal CDH. The pregnancy was uneventful until 25 weeks of gestation when level II ultrasound detected isolated right CDH. Ultrasound showed that the liver and gallbladder were located in the right hemithorax, and there was levocardia. Fetal magnetic resonance imaging confirmed the diagnosis of right CDH with the gallbladder and part of the liver appearing in the right hemithorax and the heart shifting to the left hemithorax. Amniocentesis was immediately performed. About 10 mL of amniotic fluid was sent for aCGH analysis by use of the DNA extracted from uncultured amniocytes, and 20 mL of amniotic fluid was sent for conventional cytogenetic analysis. aCGH analysis revealed the result of arr 21p11.2q22.3 (9,962,872-48,129,895) × 3, consistent with the diagnosis of trisomy 21. Conventional cytogenetics revealed a karyotype of 47,XY,+21. Postnatally, polymorphic DNA marker analysis using DNAs extracted from the placenta and parental bloods showed a heterozygous extra chromosome 21 of maternal origin consistent with the result of maternal meiosis I nondisjunction. CONCLUSION Prenatal diagnosis of right CDH should raise a suspicion of chromosomal abnormalities especially trisomy 21 and the association of Morgagni hernia.
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12
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Parsons C, Naqvi S, Wheeler R. Intra-thoracic appendicitis in a child with Down's syndrome. J Pediatr Surg 2013; 48:E29-31. [PMID: 23845654 DOI: 10.1016/j.jpedsurg.2013.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 04/01/2013] [Accepted: 04/12/2013] [Indexed: 01/20/2023]
Abstract
Morgagni congenital diaphragmatic hernias are rare. They are associated with chromosomal anomalies, especially Down's syndrome. Acute appendicitis is the most common surgical emergency in childhood, but accurate diagnosis can be a challenge if encountered out of the usual anatomical position. This is the first case report of acute appendicitis within a Morgagni hernia in a child with Down's syndrome.
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13
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Garriboli M, Bishay M, Kiely EM, Drake DP, Curry JI, Cross KM, Eaton S, De Coppi P, Pierro A. Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair. Pediatr Surg Int 2013; 29:185-9. [PMID: 23143132 DOI: 10.1007/s00383-012-3199-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Morgagni diaphragmatic hernia can be repaired laparoscopically. The aim of this study is to evaluate the outcome of this minimally invasive approach. METHODS A retrospective review was conducted on all consecutive children who underwent repair of Morgagni hernia from January 2002 to December 2011 in our hospital. Data are expressed as median (range). RESULTS There were 12 children with Morgagni hernia. Age at surgery was 7.5 months (2-125). Associated malformations were present in 7 children (58 %). All children underwent initial laparoscopic approach. Two children (16 %) underwent conversion to open surgery. The hernia was closed primarily in 11 children (92 %), using a polyester patch in 1 (8 %). There were no intraoperative or immediate postoperative complications. Five children (42 %), all repaired initially without a patch, had a recurrence of the Morgagni hernia. The repair of the recurrent hernia was performed laparoscopically in four out of the five children, and a patch was used in two patients with no further recurrences or complications. CONCLUSIONS There is a high rate of recurrence after laparoscopic Morgagni hernia repair. This is exclusively associated with laparoscopic repair without patch, and it is in contrast with the low recurrence rate reported previously. More frequent use of patch may be beneficial.
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Jetley NK, Al-Assiri AH, Al-Helal AS, Al-Bin Ali AM. Down's syndrome as a factor in the diagnosis, management, and outcome in patients of Morgagni hernia. J Pediatr Surg 2011; 46:636-639. [PMID: 21496530 DOI: 10.1016/j.jpedsurg.2010.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 09/04/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose was to study the impact of Down's syndrome (DS) in the diagnosis, management, and outcomes of patients with Morgagni hernia (MH). METHODS Twenty-two (22) patients with MH treated at a tertiary center were retrospectively studied for history, findings, associated anomalies, referral diagnoses, hospital admissions, radiological procedures for diagnosis, age at which operated on, operative procedure, complications, and recurrences. Eleven did not have DS (group 1); 11 others had associated DS (group 2). The ages at operation were compared in the 2 groups using the Mann-Whitney test. More than 3 hospital admissions for symptoms and signs relevant to MH before a diagnosis of MH were considered a "delayed diagnosis." RESULTS Twenty-two patients (7 females, 15 males) aged 3 months to 10 years were seen. They presented with respiratory distress (n = 16), with vomiting (n = 5), with intestinal obstruction (n = 1), by serendipity (n = 2), and with recurrence from another hospital (n = 1). The mean age of group 1 was 14.5 months, and that of group 2 was 29.18 months; the difference was not significant (P = .621). Nine patients of group 2 were "delayed diagnosis" compared with 2 in group 1. Both delays from group 1 had severe associated anomalies. All patients underwent operative correction (17 open and 5 laparoscopic repairs). Two had recurrences, one operated on by the open method by us and another laparoscopically by the Lima technique at another center. Both had DS. Both were reoperated on by the open method. CONCLUSIONS The diagnosis of MH may be strikingly delayed when associated with DS or other severe congenital anomalies. Morgagni hernia should be strongly considered in patients with DS admitted repeatedly for chest infections. Chest x-rays in 2 planes may avoid misdiagnosis of MH. Both open and laparoscopic methods have proven satisfactory as operative treatment of MH. Recurrences were seen in patients with DS, which may be corrected by laparotomy or laparoscopically. We feel that resecting the sac and approximating the posterior lip of the defect to the anterior abdominal wall, whether in open or laparoscopic methods, may give stronger repairs, which may avoid recurrence.
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Affiliation(s)
| | - Ali Hassan Al-Assiri
- Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Kingdom of Saudi Arabia
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15
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Laituri CA, Garey CL, Ostlie DJ, Holcomb GW, Peter SDS. Morgagni Hernia Repair in Children: Comparison of Laparoscopic and Open Results. J Laparoendosc Adv Surg Tech A 2011; 21:89-91. [DOI: 10.1089/lap.2010.0174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carrie A. Laituri
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Carissa L. Garey
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Daniel J. Ostlie
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - George W. Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Abstract
Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or mortality. These cases are combined with larger case series to arrive at a list of relatively specific clinical and radiologic findings that can alert the clinician to this diagnosis and thus expedite the child's assessment and treatment, averting major complications.
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Affiliation(s)
- J Ted Gerstle
- Division of General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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17
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Casaccia M, Barabino G, Andorno E, Nicorelli M, Porcile E, Gelli M, Diviacco P, Valente U. Split-liver transplantation in the setting of hepatic herniation due to a congenital diaphragmatic hernia in a down syndrome patient. Liver Transpl 2009; 15:449-51. [PMID: 19326421 DOI: 10.1002/lt.21597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Marco Casaccia
- Department of General and Transplant Surgery, St. Martino Hospital, University of Genoa, Genoa, Italy
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18
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Andión M, Molina B, Usano AI, Crespo D. Hernia diafragmática de Morgagni-Larrey: una rara causa de derrame pericárdico. Rev Esp Cardiol 2008. [DOI: 10.1157/13127855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The original description by Morgagni of the anterior diaphragmatic defect that bears his name implies a paramedian defect and this may be true when acquired in adulthood. In contrast, the anterior diaphragmatic defect that is observed in children is central rather than paramedian, as is often assumed. Its central retrosternal location has been confirmed by various methods, but is most clearly evident on laparoscopy.
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Affiliation(s)
- Craig A McBride
- Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
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Abstract
Morgagni hernia (MH) is a congenital herniation of the abdominal organs through the subcostosternal portion of the diaphragm. It is a rare type of diaphragmatic hernia that has been associated with other congenital anomalies. The purpose of this clinical review was to determine the incidence of associated anomalies in patients with MH at a major pediatric referral center. The medical records of all patients with the diagnosis of MH were reviewed retrospectively between 1983 and 2006. The age, sex, side of herniation, presenting symptoms and signs, associated anomalies, radiologic features, intraoperative findings, postoperative course, complications, and mortality were recorded. There were 11 males and 5 females. The average age of the patients was 34.5 months (range 2 months-14 years). Twelve patients (75%) had at least one associated congenital malformation and eight (66.6%) of them had multiple anomalies. Six (37.5%) patients had a chromosomal anomaly, Down's syndrome in five and Turner syndrome in one. MH has a high incidence of associated congenital malformations.
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Affiliation(s)
- Murat Kemal Cigdem
- Department of Pediatric Surgery, Dicle University Medical Faculty, 21280 Diyarbakir, Turkey.
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21
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Abstract
BACKGROUND Congenital Morgagni hernia (CMH) is very rare, comprising 3% to 5% of all types of congenital diaphragmatic hernia; and very little is written about it. Commonly, it is diagnosed during childhood but can remain asymptomatic till adulthood. In the pediatric age group, the presentation is usually vague and nonspecific leading to delay in diagnosis. PATIENTS AND METHODS The medical records of all patients with the diagnosis of CMH treated at our hospital were retrospectively reviewed for age at diagnosis, sex, presenting symptoms, associated anomalies, diagnosis, operative findings, treatment, and outcome. RESULTS During an 18-year period (January 1983 through December 2001), 20 cases with the diagnosis of CMH were treated at our hospital. There were 15 males and 5 females. Their age at time of diagnosis ranged from 28 days to 9 years (mean, 16 months), and most of them (65%) were younger than 1 year. Sixteen of them (80%) presented with recurrent chest infection, which most of them had had since early infancy. In 3 patients, Morgagni hernia was discovered after blunt abdominal trauma in one, after insertion of ventriculoperitoneal shunt in another, and as a result of liver enlargement after splenectomy for beta-thalassemia major in the third. Of the 20 patients, 9 had right-sided Morgagni hernia, 5 had left-sided, and 6 had bilateral hernias. In 4 of those with bilateral hernia, the diagnosis of bilaterality was made at the time of surgery. Associated anomalies were seen in 14 (70%) of our patients. Five (25%) had congenital heart disease, 4 (20%) had malrotation of bowel, and 3 (15%) had Down's syndrome. All our patients were operated on transabdominally (14 upper midline, 5 upper transverse) except for one who had a right thoracotomy. In all 3 was a hernial sac, which was excised, and the defect was repaired using nonabsorbable sutures. The contents of the hernial sac included colon, small intestines, part of the liver, and omentum, with the colon being the most common (80%). There was no mortality, and postoperatively all patients did well. One of our patients required postoperative ventilation for 5 days because of associated lung hypoplasia. CONCLUSIONS Congenital Morgagni hernia is very rare. The rarity, as well as the vague and nonspecific presentations, contributes to the delay in diagnosis. Commonly, the presentation in the pediatric age group is that of recurrent chest infection and rarely with gastrointestinal symptoms. Physicians caring for these patients should be aware of this, and a high index of suspicion is recommended to obviate delay in diagnosis with its associated morbidity. We advocate surgical repair even in asymptomatic patients. This is to obviate the risk of strangulation and colonic perforation. We also advocate a transabdominal approach via either an upper midline or an upper transverse incision. This allows easy reduction and inspection of contents, allows access and repair of bilateral hernias, and corrects an associated malrotation if present.
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Affiliation(s)
- Ahmed H Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, P.O. Box 61015, Qatif 31911, Dammam, Saudi Arabia.
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22
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Abstract
Advances in the understanding of normal diaphragm embryogenesis have provided the necessary foundation for novel insights into the pathogenesis of congenital diaphragmatic hernia (CDH). Although diaphragm formation is still not completely understood, we have identified key structures and periods of development that are clearly abnormal in animal models of CDH. The pleuroperitoneal fold (PPF) is a transient structure which is the target for the neuromuscular component of the diaphragm. The PPF has been shown to be abnormal in multiple animal models of Bochdalek CDH; specifically, a malformation of the nonmuscular component of this tissue is thought to underlie the later defect in the complete diaphragm. Based on data from animal models and the examination of human postmortem tissue, we hypothesize that abnormal PPF development underlies Bochdalek CDH. Further, the understanding of the pathogenesis of rarer subtypes of CDH will be advanced by the study of various new animal models discussed in this review.
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Affiliation(s)
- Robin D Clugston
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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23
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Abstract
A 4-month-old infant with trisomy 21 is brought to the emergency department for breathing difficulty. Subsequently, he is diagnosed with a Morgagni diaphragmatic hernia. Tachypnea in an infant with trisomy 21 may be the result of diagnosis such as congenital heart disease, infectious processes, structural anomalies, or aspiration secondary to gastroesophageal reflux or swallowing dysfunction. Knowledge of these abnormalities is important when generating a differential diagnosis in these patients. Although uncommon, a Morgagni hernia may present beyond the newborn period and should be considered when evaluating an infant with trisomy 21 and respiratory difficulty.
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Affiliation(s)
- Jennifer Marin
- Division of Emergency Medicine, Children's Hospital and Regional Medical Center, Seattle, WA 98105-0371, USA.
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Affiliation(s)
- W J Bufkin
- Department of Radiology, Baylor University Medical Center, Dallas, Texas 75246, USA
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Abstract
A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.
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Affiliation(s)
- Ibrahim Barut
- Suleyman Demirel University, School of Medicine, Department of General Surgery, Isparta, Turkey.
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van Dooren M, Tibboel D, Torfs C. The co-occurrence of congenital diaphragmatic hernia, esophageal atresia/tracheoesophageal fistula, and lung hypoplasia. ACTA ACUST UNITED AC 2005; 73:53-7. [PMID: 15602760 DOI: 10.1002/bdra.20098] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Two severe birth defects, congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), have traditionally been analyzed separately in epidemiological studies. Lung hypoplasia (LH), part of the CDH spectrum, is not usually associated with EA/TEF, yet both are foregut malformations. METHODS We conducted an epidemiological study of two combinations of the defects in the population of 3,318,966 live births and stillbirths monitored from 1983 to 1996 by the California Birth Defects Monitoring Program (CBDMP). RESULTS A total of 433 cases had a Bochdalek type CDH/LH (0.13 per 1000 births), 893 had EA/TEF (0.27 per 1000 births), and 646 had LH (0.19 per 1000 births). Among them, 18 cases had CDH/LH with EA/TEF (0.005 per 1000 births), and 53 had EA/TEF and LH (0.02 per 1000 births); both prevalences are significantly higher than expected. Sixteen of 17 cases of CDH/LH with EA/TEF, and 34 of 40 cases of EA/TEF with LH were stillborn or died; 72% and 74%, respectively, had an autopsy. The male to female sex ratios were 1.43 and 1.13, respectively. In both groups, infants had similar proportions of additional severe defects, except for genitourinary and anal defects and syndromes/associations, which were more prevalent in the EA/TEF with LH group. We reviewed human studies and experimental animal models for factors reported to cause any combination of the defects. CONCLUSIONS Several genetic and environmental factors could affect the significant co-occurrence of the defects. Future studies should include storage of patients' biological materials for DNA analysis, karyotyping, and environmental exposure evaluation.
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Affiliation(s)
- Marieke van Dooren
- Department of Pediatric Surgery, Erasmus MC Sophia, Rotterdam, The Netherlands
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27
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Abstract
OBJECTIVE Morgagni's hernia is a relatively uncommon diaphragmatic hernia with a potential for considerable morbidity, if the diagnosis is delayed or missed. This review of cases of Morgagni's hernia was undertaken in order to emphasize methods of diagnosis and treatment. METHODS From 1992 through 2002, seven patients with Morgagni's hernia (5 right, 2 left) were surgically treated at our hospital. We investigated the patients preoperatively including chest roentgenogram, chest CT scan, and contrast studies of the upper gastrointestinal tract. Operative repair was accomplished with the transabdominal or transthoracic approach. Basic spirometric tests had been carried out on patients presented for elective surgery. RESULTS The majority of patients experienced dyspnea and two patients presented with acute abdomen due to peritonitis. Diagnosis for Morgagni's hernia was made preoperatively in all but one patient. In cases with uncertain diagnosis or peritonitis, a transabdominal approach was preferred. One patient had died of septic multi-organ failure in the early postoperative course. Following elective repair of Morgagni's hernia, improvement in basic spirometric values was seen. CONCLUSIONS We conclude that repair for Morgagni's hernia can be performed safely and effectively by using different surgical approaches. The risk of progression and incarceration makes clinical awareness, early diagnosis, and surgical treatment warranted. Improvement in lung function can be expected postoperatively.
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Affiliation(s)
- J Pfannschmidt
- Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany.
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Waller DK, Tita ATN, Werler MM, Mitchell AA. Association between prepregnancy maternal body mass index and the risk of having an infant with a congenital diaphragmatic hernia. Birth Defects Res A Clin Mol Teratol 2003; 67:73-6. [PMID: 12749387 DOI: 10.1002/bdra.10003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A previous study observed that women who are underweight prior to conception were significantly more likely to have infants affected by congenital diaphragmatic hernia (CDH). The objective of the current study was to examine the association between maternal body mass index and the risk of a CDH-affected offspring based on a larger number of cases of CDH. METHODS A case control study was conducted using data collected by the Boston University Slone Epidemiology Center Birth Defects Study, which identifies infants with major malformations who are born in the metropolitan area surrounding Boston, Massachusetts; Philadelphia, Pennsylvania; and Toronto, Ontario, Canada. Control infants were selected from infants without malformations who were born in the same areas. The study included 85 cases of CDH and 655 controls delivered between 1993 and 1997. RESULTS After adjustment for maternal education and maternal age, we observed that women who were thin or underweight for their height (body mass index < or = 19.0 kg/m2) had an increased risk of having an infant with isolated CDH (OR = 1.9; 95% CI = 0.92-4.1), but no increase in the risk of having a CDH infant with multiple defects (OR = 0.86; 95% CI = 0.29-2.6) compared with all other women. CONCLUSIONS Although our finding for isolated CDH was not statistically significant (P = 0.08), it suggests that the offspring of thin or underweight women may have an increased risk of isolated CDH. This finding requires confirmation. If it is confirmed, further research on factors associated with being underweight should be explored such as diet, exercise, and use of drugs.
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Affiliation(s)
- D Kim Waller
- School of Public Health, University of Texas Houston Health Science Center, Houston, Texas 77225, USA.
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Cebrero García M, Alonso Cristobo M, Álvarez Coca J, García Frías E. Lactante con síndrome de Down y condensación persistente en lóbulo medio. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)78732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Morgagni hernia (MH) is the least common type of congenital diaphragmatic hernias. Although its course is often asymptomatic, it may be associated with various respiratory and gastrointestinal symptoms. We describe 7 children with MH during a 5-year period in three pediatric centers in Turkey. All children had acute or chronic respiratory symptoms; cough was the most frequent. The diagnosis was made by posterior-anterior (PA) and lateral chest X-rays. The PA chest X-rays showed a homogenous mass in 2 and a gas-filled cystic image in 3 children in the right cardiophrenic angle. A retrocardiac homogeneous density in one child, and bilateral consolidation in lower lung areas in another child were also seen. All lateral chest X-rays showed gas-filled bowel loops above the diaphragm. The diagnosis was confirmed by barium-contrast radiograph. Four patients had five additional anomalies, i.e., ventricular septal defect, right inguinal hernia, congenital hip dislocation, pectus carinatum, and obstruction of the uretero-pelvic junction. All of the hernias were repaired by an abdominal approach. There were no complications or recurrences during follow-up. In conclusion, MH should be considered in the differential diagnosis of cases of long-standing respiratory symptoms and/or when an unexplained radiological image, especially on the right cardiophrenic area, is present.
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Affiliation(s)
- H Soylu
- Department of Pediatrics, Inönü University, Turgut Ozal Medical Center, Malatya, Turkey.
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BECMEUR F, HORTA-GERAUD P, SCHWAAB C, CARRENARD G, TUCELLA M. Laparoscopic Treatment of a Morgagni Hernia in a Child: Case Report and Literature Review. ACTA ACUST UNITED AC 1999. [DOI: 10.1089/pei.1999.3.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Enns GM, Cox VA, Goldstein RB, Gibbs DL, Harrison MR, Golabi M. Congenital diaphragmatic defects and associated syndromes, malformations, and chromosome anomalies: A retrospective study of 60 patients and literature review. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19980923)79:3<215::aid-ajmg13>3.0.co;2-k] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Morgagni-type diaphragmatic hernias are rare. The overwhelming majority are discovered in children who usually present with pneumonia or sepsis. We report an unusual case of a 57-yr-old woman with a Morgagni hernia presenting with pulmonary symptoms. Complicating the clinical picture, the pneumonia delayed the definitive diagnosis until a lateral chest X-ray study revealed loops of bowel in the right lower lung fields. It is important to entertain abdominal etiologies in the differential diagnosis of a thoracic density.
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Affiliation(s)
- S T Lin
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center 90033, USA
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35
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Abstract
Down syndrome may be associated with many complications. Among the malignancies associated with Down syndrome, leukaemia is the most common. This is a case report of a patient with Down syndrome associated with both a retroperitoneal teratoma and a Morgagni hernia.
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Affiliation(s)
- B S Quah
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, Kelantan, Malaysia.
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