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The late-presenting pediatric Morgagni hernia: a benign condition
L Berman1, D Stringer, S H Ein
1Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Late-presenting Morgagni hernias in children are often diagnosed via gastrointestinal and respiratory symptoms. These congenital abnormalities are generally benign, with no mortality observed in this study.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
- Thoracic Surgery
Background:
- Morgagni hernias are rare congenital defects.
- Late presentation is less common than early presentation.
- Understanding late-presenting Morgagni hernias is crucial for diagnosis and management.
Purpose of the Study:
- To review clinical data of infants and children with late-presenting Morgagni hernias.
- To identify common symptoms, diagnostic methods, and associated abnormalities.
- To evaluate surgical outcomes and the overall prognosis of these hernias.
Main Methods:
- Retrospective review of 15 pediatric cases of late-presenting Morgagni hernias (presentation > 8 weeks).
- Analysis of clinical presentation, diagnostic imaging (chest x-ray, barium studies), and surgical findings.
- Assessment of postoperative outcomes and associated congenital anomalies.
Main Results:
- Most patients (10/15) were asymptomatic at presentation, with gastrointestinal and respiratory symptoms being most common.
- Chest x-ray was the primary diagnostic tool, though initial assessments varied.
- Twelve patients had other major congenital abnormalities; 14 underwent surgery with no mortality.
- Hernias frequently contained hollow viscera and often had associated abnormal bowel fixation.
Conclusions:
- Late-presenting Morgagni hernias in children are relatively benign conditions.
- Early diagnosis and surgical intervention are generally successful.
- The presence of other congenital anomalies is common but does not preclude favorable outcomes.
Abstract:
Data concerning 15 infants and children with late-presenting (more than 8 weeks) Morgagni hernias over the last 20 years (1966 to 1986) have been reviewed. Ten of the cases were clinically normal on presentation, and the most common symptoms and signs were gastrointestinal and respiratory. Only one child presented with acute symptoms. Five had previously normal chest x-rays, and two others had an incorrect initial radiologic assessment. Chest x-ray was the most common diagnostic test; preoperative barium studies were performed in three patients. Twelve patients had other major congenital abnormalities. Fourteen of the 15 had surgery, usually within days of presentation. At operation, 10 of the 14 hernias contained a hollow viscus, nine had a sac, and four had abnormal bowel fixation. Postoperatively, two children had radiologic evidence of impaired diaphragmatic motility. There was no mortality in this series. Overall, late-presenting Morgagni hernias are relatively benign.