Morgagni Hernia in childhood

ABSTRACT

Three hundred and twenty five infants and children with congenital diaphragmatic hernia have been managed at the Hospital for sick children, Great Ormond Street, [GOS], London since January 1950 to January 1994. Twenty four of this series had the uncommon anterolateral hernia of Morgagni and are the subject of this study. Twenty infants and children presented with respiratory and gastrointestinal symptoms, while in four the diagnosis was incidental. Eight infants and children presented acutely with respiratory and gastrointestinal system. The diagnosis was made using plain chest x-ray and upper gastrointestinal contrast studies. Three children had normal chest x-ray. Angiography was performed in two patients for cardiac defects and this also confirmed the herniation of the left ventricular diverticulum into the abdomen. A further patient required operative splenoportogram because of suspected portal vein thrombosis and to plan shunt procedure. Eleven children had formal repair of the diaphragmatic defect A hernial sac was present in 16. Four children had malrotation. The operative findings were herniation of the small and large bowel, left lobe of the liver, omentum, spleen, stomach, diverticulum of the left ventricle and segment of the right lung. One patient had bilateral hernia. Postoperative complications occurred in eight patient's and were adhesive small bowel obstruction in 4, pleural effusion in 2, pericardial effusion in 2, wound infection in 2, recurrent hernia in one, impaired right diaphragmatic motility in one, and portal hypertension in another. There was no mortality