Treatment of Morgagni hernias by transabdominal approach / Tratamiento de las hernias de Morgagni mediante el abordaje transabdominal

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Antecedentes: Recientemente, se ha sugerido el empleo del abordaje torácico en el tratamiento de las hernias de Morgagni, reportándose algunas ventajas del mismo sobre la cirugía abdominal. Este trabajo reporta la experiencia de los autores en relación con hernias de Morgagni en la infancia, reparadas mediante laparotomía. Sujetos y métodos: Las historias clínicas de cinco casos de hernias de Morgagni operadas en nuestro departamento, fueron evaluadas con respecto a edad, presentación, datos operatorios, complicaciones, y resultado. Resultados: La edad promedio de cuatro pacientes varones y una hembra fue de 34 meses (rango de 6 meses a 8 años). Los síntomas presentados estuvieron relacionados de forma predominante con el sistema respiratorio. Los diagnósticos se hicieron mediante rayos X posterior-anterior y lateral de tórax, y confirmados luego mediante estudio radiográfico de contraste con enema de bario. Se detectaron anomalías asociadas en tres casos. Todos los casos fueron manejados mediante abordaje abdominal a través de incisiones de la línea media superior, reduciendo así la víscera herniada (colon transversal en todos, incluyendo el omento en un paciente) y practicando la excisión del saco de la hernia, presente en todos los pacientes. El período post-operatorio no presento incidentes en esta serie, y no se detectó recurrencia durante el seguimiento, que duró un promedio de cuatro años. Conclusión: El abordaje transabdominal es apropiado en la corrección quirúrgica de las hernias pediátricas de Morgagni.

Treatment of Morgagni hernias by transabdominal approach.

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Neonatal ovarian cyst associated with intestinal obstruction.

Cystic and solid tumors of the ovary are rare during the newborn period and infancy. We present the case of a term female infant born to a mother with 24 years of age and found to have a cystic abdominal mass through prenatal sonographic evaluation in the third trimester. The cyst was also demonstrated by postnatal abdominal ultrasonography. Because of the clinical and radiological findings of intestinal obstruction, laparatomy was performed at the age of three days and a cyst of 10' 8' 8 cm was found in the right ovary. Pathological examination of cyst revealed a teach-lutein cyst.

Keutel syndrome: a report of four cases.

We report four new cases of Keutel syndrome. Clinical manifestation included abnormal cartilage ossification, multiple peripheral pulmonary stenosis (PPS), brachytelephalangism, subnormal IQ, repeated respiratory infections, otitis media and hearing loss. All four children have a typical facial appearance and are of consanguineous parents. Father and the fifth offspring exhibit a normal phenotype; the mother has pulmonary stenosis. This observation confirms Keutel syndrome as a distinct autosomal recessive syndrome.