ASEMPTOMATİK YETİŞKİNDE TESADÜFEN SAPTANAN MORGAGNİ HERNİSİ VE EKSTRALOBER PULMONER SEKESTRASYON BİRLİKTELİĞİ

Year 2011, Volume: 25 Issue: 3, 197 - 201, 01.12.2011

Ekrem Şentürk Serdar Şen Selda Şen İbrahim Meteoğlu

Abstract

Morgagni hernisi (MH), Larr ey aralığı olarak bilinen sternokostal üçgen ya da ön retrosternal diaframdan gelişen nadir konjenital diafragmatik bir defekttir. MH tüm diafragmatik hernilerin %5'inden azını oluşturur. MH genellikle asemptomatiktir, nadiren barsak obstruksiyonu veya strangulasyonu ile hayati tehdit oluşturabilir. MH beraberinde malformasyonlar görülebilir. Pulmoner sekestrasyon (PS) anormal sistemik arteriel kanlanma gösteren kistik ve nonfonksiyone embriyonik akciğer dokusu ile karakterize konjenital malformasyondur. PS sıklıkla sol akciğer alt lobda (%60-90) lokalize olmak üzere intralober sekestrasyon (İS); (%75) ve ekstralober sekestrasyon (ES); (%25) olarak iki gurupta incelenir. Asemptomatik yetişkin erkekte tesadüfen saptanan nadir bir MH ve ES olgusunu paylaşmak istedik. Olguya posterolateral torakotomi uygulanarak, sekestrasyon eksizyonu ve primer herni onarımı yapıldı. Transtorasik yaklaşımın; iyi bir görüş alanı sağlaması, herni kesesinin çevre dokularla oluşturduğu yapışıklıkların kolay serbestleştirilmesi nedeniyle ES gibi intratorasik malformasyonların beraberliği düşünülen olgularda uygun yaklaşım olduğunu düşünmekteyiz.

Keywords

Morgagni hernisi, Ekstrapulmoner sekestrasyon, Transtorasik yaklaşım

MORGAGNI HERNIA WITH EXTRALOBAR PULMONARY SEQUESTRATION PRESENTED IN ASYMPTOMATIC ADULT WHICH WERE DIAGNOSED TO COINCIDENTALLY

Abstract

Morgagni hernia (MH) is a rare diaphragmatic
congenital defect originated in the the sternocostal
triangle or the anterior part of the retrosternal
diaphragm referred to as Larrey’s space. It is the
rarest of all diaphragmatic hernias (<5%).
Although is usually asymptomatic it can be lifethreatening
because of bowel obstruction or
strangulation. MH might also present with
associated malformations. We performed
procedures of excision of sequestration and
primer hernia repair under the posterolatheral
thoracotomy. Pulmonary sequestration (PS) is a
congenital malformation characterised by cystic,
non-functioning embryonic lung tissue with
vascularisation of an abnormal systemic artery.
They are classified as intralobar (75%) and
extralobar (25%) and are more common in the
left lung and lower lobes (60-90%). We report a
rare case of Morgagni hernia with extralobar
pulmonary sequestration (ES) presented in
asymphtomatic adult man which were diagnosed
to coincidentally. We think that; for the surgical
treatment of foramen of MH, the transthoracic approach is the most convenient way to provide
good exposure, enabling easy release of the adhesions
between the sac and the adjacent tissues and
also associated malformations like as ES.

Keywords

Morgagni hernia, Extrapulmonary sequestration, Transthoracic approach

References

• 1. Srikanth Ms, Ford EG, Stanley P, Mahour GH. Communicating bronchopulmonary foregut malformations: classification and embryogenesis. J Pediatr Surg 1992; 27: 732-6.
• 2. Karl G. Slyvester, Craig T. Albanese. Bronkopulmonary malformations. In: Keith W. Aschcraft, George W. Holcomb, III, J. Patrick Murphy, Pediatric Surgery, Elsevier Saunders, Forth Edition, 2005; 276-89.
• 3. Comer TP, Clagett OT. Surgical treatment of hernia of the foramen of Morgagni. J Thorac Cardiovasc Surg 1966 ;52: 461-8.
• 4. Bragg WD, Bumpers H, Flynn W, et al. Morgagni hernias: an uncommon cause of chest masses in adults. Am Fam Physician 1996; 54: 2021-4.
• 5. Fell SC. Surgical anotomy of the diaphragm and the phrenic nerve. Chest Surg Clin Am 1998; 8: 281-94.
• 6. Yüksel M, Kalayc› G. Konjenital akci¤er hastal›klar›. Gö¤üs cerrahisi, Editör Yüksel M, Kalayc› G. Özlem Grafik Matbaac›l›k, ‹stanbul 2001: 782-3.
• 7. Williams R. Congenital diaphragmatic hernia. A review. Heart and lung 1982; 11: 532-8.
• 8. Berman L, Stringer D, Ein SH. The latepresenting pediatric Morga gni hernia: A benign condition. J Pediatr Surg 1989; 24:970-2.
• 9. Alizivatos P, Cheatle T, de Leval M, Stark J. Pulmonary sequestration complicated by anomalies of pulmonary venous return. J Pediatr Surg 1985; 20: 76.
• 10. Laberge JM, Puligandla P, Flageole H. Asymptomatic congenital lung malformations. Semin Pediatr Surg 2005; 14: 16-33.
• 11. Senturk E, Pabuscu E, Sen S, Meteoglu I. A rare association; pulmonary blastoma developing on extrapulmonary sequestration basis. Interact Cardiovasc Thorac Surg. 2010; 11(1): 110-1.
• 12. Steiner Z, Mares AJ. Anterolateral diaphragmatic hernia: Is’t Morgagni Hernia? Eur J Pediatr Surg 1993; 3: 112-4.