Congenital retrosternal diaphragmatic Morgagni hernia: diagnosis and surgical correction in children

Sliepov O. K., Kurinnyi S. I., Ponomarenko O. P. 
SI «Institute of Pediatrics, Obstetrics and Gynecology of National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine

Objective: to study the incidence, clinical and anatomical peculiarities of Morgagni hernias, to develop diagnostic algorithm and methods of surgical correction for this malformation.

Materials and methods. At the department of surgical correction for congenital anomalies in children of the SI «IPOG NAMSU», 185 children with different anatomical types of congenital diaphragmatic hernia (CDH) were treated during last 20 years. 6 children had Morgagni hernias. We used clinical, radiological, ultrasound and statistical research methods.

Results. Incidence of Morgagni hernias is 3.2% of all diaphragmatic hernias. Clinical signs of this malformation were: lag in physical development (n=4), short breath (n=3), recurrent broncho-pulmonary diseases (n=3), non-specific dysfunctions of alimentary canal (constipations — 2, pain in abdomen — 1). Diagnostic algorithm included: plain chest and abdominal X-ray (n=6), passage (n=3), irrigography (n=2), ultrasonography (n=6) and computed tomography (n=2). All patients (n=6) were treated surgically. We used laparotomy approach (n=5) and thoracotomy (n=1). Surgery consisted of hernia sac excision with diaphragm plasty using local tissues. Hernia contents were: transverse colon (n=3), liver (n=4), great omentum (n=1). There were no intraoperative and postoperative complications.

Conclusions. Congenital diaphragmatic Morgagni hernia — a rare congenital anomaly which composes 3.2% of all CDH. Recurrent bronco-pulmonary diseases and lag in physical development — the most common clinical signs. Developed diagnostic algorithm includes: plain chest and abdominal X-ray, radiographic contrast study (passage or irrigography), ultrasound examination and computed tomography. Treatment is surgical. It is advisable to use laparotomy approach, remove of the hernia sac and diaphragm plasty using local tissues.

Key words: congenital retrosternal diaphragmatic Morgagni hernia, diagnosis, surgical treatment, children.

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