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Archives of Gynecology and Obstetrics

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01-11-2016 | Maternal-Fetal Medicine

Morgagni hernia presenting with massive pericardial effusion and ascites: prenatal management by thoraco-amniotic shunting and fetal endoscopic tracheal occlusion (FETO) and review of the literature

Authors: A. Zamprakou, C. Berg, B. Strizek, A. Müller, A. Heydweiller, U. Gembruch, A. Geipel

Published in: Archives of Gynecology and Obstetrics | Issue 5/2016

Abstract

Background

Morgagni hernia presents a rare type of congenital diaphragmatic hernia (CDH, about 2–5 %) (Herman, J Perinatol 21:343–344, 2001), which is characterized by an anterior mainly right-sided defect of the diaphragm. Infrequently, this is combined with a herniation of the liver into the pericardial cavity (Aké, Prenat Diagn 11:719–724, 1991; Stevens, Pediatr Radiol 26:791–793, 1996). This may cause massive pericardial effusion and subsequently lung hypoplasia (Pober et al., Congenital diaphragmatic hernia overview, University of Washington, Seattle, 2015; Ikeda, J Perinat Med 30:336–340, 2002; Hara, J Obstet Gynaecol Res 33:561–565, 2007). So far only few cases have been reported in fetal life.

Case

We report a case of Morgagni hernia with pericardiodiaphragmatic aplasia, complicated by two-compartment effusions (massive pericardial effusion and mild ascites), diagnosed in the second trimester. The case was successfully managed in utero with thoraco-amniotic shunting and late tracheal occlusion, followed by corrective surgery after birth.

Discussion

A review of the literature was performed, identifying 13 cases of prenatally diagnosed Morgagni hernia. The diagnosis was established by the sonographic findings of pericardial effusion und intrathoracic herniation of the liver. In only two cases a prenatal intervention was carried out. All neonates were operated postnatally with excellent final outcome.

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Title: Morgagni hernia presenting with massive pericardial effusion and ascites: prenatal management by thoraco-amniotic shunting and fetal endoscopic tracheal occlusion (FETO) and review of the literature
Authors: A. Zamprakou
C. Berg
B. Strizek
A. Müller
A. Heydweiller
U. Gembruch
A. Geipel
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 5/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-016-4103-0

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Morgagni hernia presenting with massive pericardial effusion and ascites: prenatal management by thoraco-amniotic shunting and fetal endoscopic tracheal occlusion (FETO) and review of the literature

Abstract

Background

Case

Discussion

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