Bilateral Morgagni hernia in a two-month-old infant with a history of umbilical cord hernia status-post repair in neonatal period

Abstract

Morgagni hernias (MH) are a rare form of congenital diaphragmatic hernia (CDH) characterized by herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. MH constitutes <5% of all CDH.1 Approximately 90% of MH are on the right side. MH has variable clinical presentations. Most of the cases are not discovered until later in childhood or adulthood. The differential diagnosis of MH is quite extensive and includes a pericardial cyst, loculated pneumothorax, or a hiatal hernia. MH is associated with other congenital anomalies, such as congenital heart diseases, chest wall deformities, intestinal malrotation, omphalocele, gastroschisis and chromosomal anomalies (e.g., trisomies 13, 18 and 21).2 Co-occurrence of a midline defect with MH is a rare finding frequently linked to other anatomical anomalies and genetic disorders.3 However, cases in which the etiology is unclear have also been reported.4 Concurrent MH and umbilical cord hernia (UCH) have not been reported so far. UCH may be easily misdiagnosed as a small omphalocele to similar morphologic features (Covering eviscerated abdominal contents with a sac comprising outer amnion and inner peritoneal lining). Unlike an omphalocele, UCH has an intact abdominal wall with adequate muscle development and a complete umbilical ring covered by a small skin cuff measuring ∼2.5 cm5. The possible association of UCH with the omphalomesenteric duct (OMD), especially with prolapsed persistent omphalomesenteric duct (POMD) in UCH, is possible but quite rare.5