Congenital Morgagni’s hernia in infants and children: a national review

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Abstract

Background

Congenital Morgagni’s hernia (CMH) is rare and has unique features in terms of clinical presentation, high incidence of bilaterality, and associated anomalies. This is a review of all CMH cases reported from Saudi Arabia, highlighting clinical features, associated anomalies, aspects of diagnosis, and management.

Patients and methods

A Medline search was made for all manuscripts published from Saudi Arabia on CMH. The total number of patients, their age at diagnosis, sex, clinical features, associated anomalies, site of hernia, and methods of treatment were recorded.

Results

From 1991 to 2014, 19 manuscripts were published from Saudi Arabia. The total number of patients reported was 106 (72 male and 31 female). In three patients, the sex was not reported. Their mean age was 23.8 months (1 month–9 years). Recurrent chest infection was the most common presentation [56 (54.4%)]. In seven (6.8%) patients, the hernia was discovered incidentally and 19 (18.4%) presented acutely. Associated anomalies were seen in 66 (64%) of 103 patients. Down’s syndrome (30%) and congenital heart disease (23%) were the most common. Sixty-four (60.4%) underwent repair through an abdominal approach, 36 (34%) underwent laparoscopic-assisted repair, and in five (4.7%) patients the hernia was repaired laparoscopically. In 94 patients, the site of the hernia was specified [45 (47.9%) right, 22 (23.4%) left, and 27 (28.7%) bilateral]. Four (3.8%) developed recurrences and three had an incisional hernia. One developed midgut volvulus 3 years postoperatively.

Conclusion

CMH is rare and the presentation is nonspecific and variable but the majority present with repeated attacks of chest infection. Physicians caring for these patients should be aware of this, and infants and children with repeated attacks of chest infection should be investigated. It is also important to evaluate these patients for possible associated anomalies, including an echocardiogram. Once the diagnosis of CMH is confirmed, they should be repaired surgically regardless of whether symptomatic or asymptomatic. The laparoscopic-assisted approach is a simple, safe, and sound technique, and leaving the hernia sac intact has no adverse effects.

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