MORGAGNI HERNIAS

Morgagni Hernias (MH) are rare congenital diaphragmatic defects close to the anterior midline between the costal and sternal origin of the diaphragm. They occur retrosternally in the midline or more commonly on either side (parasternally) of the junction of the embryologic septum transversum and thoracic wall (see the figure) representing less than 2% of all diaphragmatic defects. Almost always asymptomatic, typically present in older children or adults with minimal gastrointestinal symptoms or as incidental finding during routine chest radiography (mass or air-fluid levels). Infants may develop respiratory symptoms (tachypnea, dyspnea and cyanosis) with distress. Cardiac tamponade due to protrusion into the pericardial cavity has been reported. The MH defect contains a sac with liver, small/ large bowel as content. Associated conditions are: heart defects, trisomy 21, omphalocele, and Cantrell’ pentalogy. US and CT-Scan can demonstrate the defect. Management is operative. Trans-abdominal subcostal approach is preferred with reduction of the defect and suturing of the diaphragm to undersurface of sternum and posterior rectus sheath. Large defects with phrenic nerve displacement may need a thoracic approach. Results after surgery rely on associated conditions.