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Congenital Morgagni's hernia and associated anomalies (Abstract)

Ahmed H. Al-Salem FRCSI, FACS, FICS

Department of Pediatric Surgery, Maternity and Children Hospital

Dammam, Saudi Arabia



Background: Congenital Morgagni's hernia (CMH) is very rare. In the pediatric age group, CMH commonly causes recurrent chest infection and has a high incidence of associated anomalies.

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 1989 - December 2007), 23 cases with CMH were treated. There were 16 males and 7 females. Their age at diagnosis ranged from 28 days to 9 years (mean 14 months). Ninteen (82.6%) presented with recurrent chest infection. Nine had right Morgagni's hernia, 6 left side and 8 had bilateral hernias. In 5, the diagnosis of bilaterality was made at the time of surgery. Associated anomalies were seen in 18 (78.3%). Eight (34.8%) had congenital heart disease, 5 (21.7%) had malrotation and 6 (26%) had Down's syndrome. All were operated on transabdominally (14 upper midline, 7 upper transverse) except two. One had a right thoracotomy while the other underwent laparoscopic repair. In all there was a hernial sac which was excised and the defect was repaired using non absorbable sutures. The contents included colon, small intestines, part of the liver and omentum with the colon being the commonest (82.6%). There was no mortality. One required postoperative ventilation for 5 days because of associated lung hypoplasia. On follow-up, 2 (8.7%) developed recurrence.

Conclusions: CMH is very rare. In the pediatric age group the presentation is commonly recurrent chest infection. 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. CMH has a high incidence of associated anomalies, namely congenital heart disease, malrotation and Down's syndrome. Down's syndrome may have a negative influence on the final outcome in the form of recurrence. We advocate a transabdominal approach either via an upper midline or an upper transverse incision. This allows easily reduction and inspection of contents, allows access and repair of bilateral hernias and correct an associated malrotation if present.

Key words: congenital diaphragmatic hernia, congenital Morgagni's hernia, associated anomalies, treatment.


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