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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 11

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 11

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Thirty month old female with incidentally noted loops of bowel in the chest.

Clinical History:
This patient was a two and a half year old female who was recently in a motor vehicle accident. At that time, she was incidentally noted to have bowel behind the sternum on a chest film. Upon further questioning, the child was noted to have a history of epigastric discomfort, especially when laying down to go to bed at night. There was no history of respiratory distress.

Clinical Physical Exam:

Clinical Labs:

Clinical Differential Diagnosis:
Morgagni hernia

Imaging Findings:
An outside chest film taken at the time of the accident demonstrated a loop of bowel in the chest, and this was confirmed on repeat films obtained one week later.

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Imaging Differential Diagnosis:
Morgagni hernia.

Operative Findings:
Six weeks later the hernia was fixed electively via an upper midline incision from the xiphoid to several cm above the umbilicus. The transverse colon was herniating through the defect into the retrosternal space. The defect in the diaphragm measured 7 cm in width and 3 cm in depth. The colon was easily reduced into the abdominal cavity and the diaphragmatic defect was then closed.

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Pathological Findings:

Final Diagnosis:
Diaphragmatic Hernia, Morgagni

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 8, Case 26


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