• Journal of Chest Surgery
• /
• v.16 no.2
• /
• pp.221-225
• /
• 1983

Morgagni, in 1760, 1st. described the findings of substernal herniation of abdominal contents into the thoracic cavity, based upon 25 postmortem dissections. Herniation through the foramen of Morgagni is the rarest occurrence of the congenital diaphragmatic hernias and is usually a few symptoms. With the increasing use of routine chest roentgenogram & the need to exclude the possibility of a mediastinal neoplasm, most such cases are brought to the attention of a surgeon. We had experienced 2 cases of Morgagni hernia, which one caused a simple mechanical intestinal obstruction & diagnosed as acute appendicitis with perforation & another one was diagnosed as mediastinal lipoma on routine chest X-ray film at arrival due to traffic accident. We had performed left paramedian abdominal incision as misdiagnosis of acute appendicitis with perforation and repair of the defect and returned transverse colon & stomach into abdominal cavity in one patient. And in another patient, we preferred to approach through right thoracotomy incision and then left upper paramedian abdominal incision and returned the omentum into the abdominal cavity. The post-operative courses were in uneventful and we report these cases and review and discuss the literatures.

• Advances in pediatric surgery
• /
• v.6 no.1
• /
• pp.1-9
• /
• 2000

Despite of advances in perinatal management and treatment modalities congenital diaphragmatic hernia(CDH) remains a frustrating problem. Although the sheep has proven to be a reliable experimental model for the production of intrauterine CDH, the rabbit may have some advantages. These include lower cost, smaller body size, year-round availability, high number of fetuses per pregnancy, and short gestational period. To evaluate the feasibility of the rabbit model of CDH, twenty-seven pregnant New Zealand rabbits were utilized. Hysterotomy and an operative procedure for creating a diaphragmatic defect on gestational day 24 or 25, in two fetuses of each pregnant rabbit were performed. In one fetus of one cornu of the uterus, the left fetal diaphragm was excised through an open thoracotomy(DH group). In another fetus in the other cornu, CDH was created and the trachea clipped(Surgiclip, USSC, Norwalk, Conn., USA) (TL group). Delivery was by Cesarean section on 30 days of gestation. Among twenty- seven pregnant rabbits, 12 in the DH group and eight in the TL group were born alive. The most common herniated organ was the left lobe of the liver. In thee DH group, the lungs were hypoplastic with decreased lung weight/body weight ratio, reduced numbers of alveoli, thicker media of the pulmonary arteries, and immature alveoli. In TL group, the alveoli were more mature and did not differ from the control animals. In conclusion, (1) pulmonary hypoplasia develops in the fetal rabbit diaphragmatic hernia model and (2) simultaneous tracheal ligation prevents pulmonary hypoplasia.

• Journal of Chest Surgery
• /
• v.7 no.2
• /
• pp.163-168
• /
• 1974

Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.