Herniation through the foramen of Morgagni: early diagnosis and treatment

Abstract

The majority of congenital diaphragmatic hernias (CDH) occur through the foramen of Bochdalek; herniation through the foramen of Morgagni (MH) is rare. Fifteen children (12 males and 3 females) with congenital MH (7 right, 3 left, 5 bilateral) were treated over a period of 15 years, comprising 11% of a total of 135 children with different types of CDH. The majority (12, 80%) had repeated chest infections. In 1 the hernia was discovered accidentally during evaluation of trauma, and another presented in the neonatal period with acute respiratory distress (ARD). The diagnosis was made on plain lateral chest radiograph when there was anterior herniation of bowel loops, and in these cases the diagnosis was confirmed by barium enema. Computed tomography was useful in preoperative diagnosis when the hernia contents were solid. All patients were operated upon transabdominally except 1, and in all cases there was a hernia sac. Associated anomalies were present in 10 (66.7%) patients: 4 (26.7%) had malrotation, 4 (26.7%) congenital heart disease, and 3 (20%) Down's syndrome. Our study shows a relatively high frequency of MH in our patients. MH rarely presents in the neonatal period, but when it does, it causes ARD. The majority of patients with MH present beyond the neonatal period with repeated attacks of chest infection, and although late-presenting MH is relatively benign, it nevertheless causes significant morbidity. Thus, clinical awareness and early diagnosis and surgical treatment are important factors.

Bowel sounds in the chest: An uncommon presentation of adult hernia

“…Very few adult patients present with chest symptoms, the majority describing abdominal pain due to strangulation of the viscera 4 . MH usually presents with recurrent chest infections in children (55%) and lateral chest radiographs are usually always conclusive [ 6 ]. Screening may apply to children with increased risk associated anomalies and familial forms of congenital diaphragmatic hernias (from 34% to 50%) [ 7 ].…”

Bilateral Morgagni Hernia: Primary Repair without a Mesh

“…Primary repair can be done by transabdominal or transthoracic approach. The thoracic approach is preferably used in cases where there is a question as to Morgagni hernia and other thoracic abnormalities, such as a mediastinal cyst or mass or a bronchogenic carcinoma [12, 13, 14], although with the advances in preoperative imaging the technique is less frequently applied. The transabdominal approach is favoured when the diagnosis is certain, as it allows easier reduction of the hernia, especially for bilateral hernias.…”

Neumonía recurrente en lactante con síndrome de Down, hernia diafragmática congénita de Bochdalek e hipotiroidismo congénito. Reporte de caso

“…4 La HDC, al ser un defecto en el desarrollo del diafragma, permite que las vísceras abdominales se hernien hacia el tórax; existen teorías que atribuyen el defecto a fallas en el cierre de los pliegues pleuroperitoneales entre la cuarta y décima semana de gestación. 5 En general, podemos encontrar dos tipos de hernias: la hernia de Bochdalek que es un defecto anatómico en la parte posterolateral del diafragma y suele predominar sobre el lado izquierdo del tórax; por otro lado, la hernia de Morgagni, se trata de una unión deficiente de la cara anteromedial del diafragma sobre las costillas y el esternón, permitiendo así que las vísceras abdominales entren en la cavidad torácica por la parte anterior de la caja; la mayoría de estos defectos predominan sobre el lado derecho del tórax, aunque en raras ocasiones se han reportado del lado izquierdo o incluso bilaterales, 6 se estima una incidencia de uno por cada 2,000-5,000 nacidos vivos y representa 2% de la totalidad de los casos de HDC. 5 Más aún, dentro de lo poco frecuente, se ha reportado a la hernia de Morgagni como la que se encuentra siempre presente en la asociación de HDC y síndrome de Down.…”