Obstructive jaundice secondary to Morgagni hernia in an infant with Fontan circulation

Abstract

The vast majority of congenital diaphragmatic cases present with severe respiratory distress in the immediate neonatal period. Obstructive jaundice secondary to CDH is a rare presenting symptom, previously unreported with Morgagni type hernias which comprise 2% of all CDHs. Although the safety of minimally invasive repair for CDH has been shown previously, there has been little data on its safety for patients with complex congenital cardiac disease. In this case report, we present an 18-month old infant with Fontan circulation presenting with jaundice secondary to Morgagni hernia who ultimately underwent laparoscopic repair. A brief discussion of the safety of laparoscopic surgery in patients post-Fontan is included.

A case report of Fontan procedure-related hepatocellular carcinoma: pure laparoscopic approach by low and stable pneumoperitoneum

“…Laparoscopic surgery in patients with Fontan circulation is a hemodynamic challenge because the venous return may be compromised by insufflation of carbon dioxide into the abdomen, use of the reverse Trendelenburg position, and positive pressure ventilation. Recently, there have been reports about laparoscopic surgeries such as cholecystectomy, pheochromocytoma excision and Morgani hernia after the Fontan procedure [7][8][9]. However, there was a potential risk by difficulty of bleeding control because of high central venous pressure (CVP) in addition to congestive liver and liver cirrhosis, and laparoscopic hepatectomy after the Fontan procedure have rarely been reported [6].…”