Bilateral Morgagni hernias association with left Bochdalek diaphragmatic hernia: a very rare anomaly.

Morgagni hernia association with Bochdalek diaphragmatic hernia is a very rare congenital anomaly. The authors reported a 2-year-and-2-month-old boy with Down syndrome who has a history of recurrent pneumonia over a one-year period. A chest film of the first admission at 6 months of age revealed only minimal pulmonary infiltration and normal findings of both sides of the diaphragm. The last investigations with chest films and CT scan were suggestive of sequestration of the right lung with left Morgagni and left Bochdalek diaphragmatic hernias. An exploratory laparotomy revealed bilateral Morgagni and left Bochdalek hernias with hernial sacs in all of the diaphragmatic defects. All of the hernial sacs were excised and the diaphragmatic defects were closed with 2-0 silk interruptedly. Postoperative course was uneventful and he was doing well during his follow-up at one year.

Conjoined twins: surgical separation in 11 cases.

Eleven pairs of symmetrically conjoined twins underwent surgical separation at the Queen Sirikit National Institute of Child Health. Six were omphalopagus, 4 were thoracopagus and 1 was pygopagus. Eight were female and 3 were male. Three pairs were separated on emergency or semi-emergency bases, and the remaining 8 pairs were separated electively at an older age. Of the 3 pairs who had early emergency separations, one pair, whose combined birth weight was only 2,500 g, underwent emergency separation at the age of 44 days after the death of one twin. The second twin also expired one hour after the separation. In the remaining 2 pairs, early separation was done because of the deterioration of one twin due to complex cardiac anomalies. In both cases, the infants with cardiac anomalies expired but the others survived the separation satisfactorily. In one pair of thoracopagus conjoined twins, one twin had cyanotic cardiac anomalies. They were electively separated at the age of 2 years and 9 months. The twin with cardiac anomalies expired 2 hours after surgery, but the other survived the separation satisfactorily. In the remaining 7 pairs who underwent elective separations, both twins of each pair survived the separation satisfactorily. However, one twin expired unexpectedly 10 days after the separation.