Rare form of congenital diaphragmatic hernia: it represents only 3 to 5%

of cases. It occurs at the level of the anterior part of the diaphragm, behind the sternum and does not lead to pulmonary hypoplasia. It is often recognized late because its symptoms are not specific:

-        repeated respiratory infections since childhood; rarely respiratory distress

-        rarely digestive occlusion (at the level of the colon).

It is more often located on the right that on the left side (it is called Larrey's hernia) and can be bilateral (30% in some series). Another anomaly is associated in 70% of cases: cardiac malformation (25%), trisomy 21 (15%) or intestinal malrotation (20%).

The treatment is surgical, sus-umbilical laparotomy or laparoscopy.

Anesthetic implications:

respiratory failure by pulmonary hypoplasia is exceptional. Echocardiography to exclude associated abnormalities. Risk of pneumopericardium if the surgeon excises the hernial sac.

References : 

-         Al-Salem A. 
Congenital hernia of Morgagni in infants and children. 
J Pediatr Surg 2007 ; 42 : 1539-43.

Update: December 2018