First one with correct answer with justification win.

 

A 3 yo female with symptoms consistent with a viral pulmonary illness has a chest x-ray. The most appropriate next step is

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[size=20px]A Observation

 

B Upper GI series

 

C CT Scan

 

D Laparoscopic repair

 

E Thoracoscopic repair[/size]

B Upper GI series

think again my dear

D Laparoscopic repair

D Laparoscopic repair

Correct

 

Morgagni hernias account for 3-4% of congenital diaphragmatic hernias, and occur when the septum transversum fails to fuse with the inferior-anterior thoracic wall, resulting in an anteromedial diaphragmatic defect. Approximately 50% of Morgagni hernias are right sided, 25% are left sided and 25% are bilateral. 95% of Morgagni hernias have a sac, and typically contain colon, liver, small bowel or omentum. Clinical presentation can occur at any time, but most often in toddlers who may have mild respiratory symptoms (which may or may not be attributable to the hernia), which leads to a chest X-ray and coincidental diagnosis.

 

 

Plain X-rays, including an adequate lateral film, are usually considered sufficient to confirm the diagnosis; although occasionally a CT scan may be necessary. Associated anomalies may include trisomy 21, congenital heart disease, and malrotation. Despite the latter association, there have not been recommendations in support of routine contrast studies in asymptomatic patients.

 

Although there can be debate on the need for correction in a truly asymptomatic case, most surgeons advocate for surgical repair, as there is always the potential for incarceration and strangulation of the colon. Most authors agree that an abdominal (laparoscopic or open) approach is preferred, usually with sac excision and direct suturing of the defect. There is a theoretical risk of increased recurrence if the hernia sac is not excised; however, there is insufficient follow up data to confirm or refute this concern.

[center]Morgagni Post op CXR

 

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