title: Down's syndrome as a factor in the diagnosis, management, and outcome in patients of Morgagni hernia.
abstract: OBJECTIVE
  The purpose was to study the impact of Down's syndrome (DS) in the diagnosis, management, and outcomes of patients with Morgagni hernia (MH).
  
  
  METHODS
  Twenty-two (22) patients with MH treated at a tertiary center were retrospectively studied for history, findings, associated anomalies, referral diagnoses, hospital admissions, radiological procedures for diagnosis, age at which operated on, operative procedure, complications, and recurrences. Eleven did not have DS (group 1); 11 others had associated DS (group 2). The ages at operation were compared in the 2 groups using the Mann-Whitney test. More than 3 hospital admissions for symptoms and signs relevant to MH before a diagnosis of MH were considered a "delayed diagnosis."
  
  
  RESULTS
  Twenty-two patients (7 females, 15 males) aged 3 months to 10 years were seen. They presented with respiratory distress (n = 16), with vomiting (n = 5), with intestinal obstruction (n = 1), by serendipity (n = 2), and with recurrence from another hospital (n = 1). The mean age of group 1 was 14.5 months, and that of group 2 was 29.18 months; the difference was not significant (P = .621). Nine patients of group 2 were "delayed diagnosis" compared with 2 in group 1. Both delays from group 1 had severe associated anomalies. All patients underwent operative correction (17 open and 5 laparoscopic repairs). Two had recurrences, one operated on by the open method by us and another laparoscopically by the Lima technique at another center. Both had DS. Both were reoperated on by the open method.
  
  
  CONCLUSIONS
  The diagnosis of MH may be strikingly delayed when associated with DS or other severe congenital anomalies. Morgagni hernia should be strongly considered in patients with DS admitted repeatedly for chest infections. Chest x-rays in 2 planes may avoid misdiagnosis of MH. Both open and laparoscopic methods have proven satisfactory as operative treatment of MH. Recurrences were seen in patients with DS, which may be corrected by laparotomy or laparoscopically. We feel that resecting the sac and approximating the posterior lip of the defect to the anterior abdominal wall, whether in open or laparoscopic methods, may give stronger repairs, which may avoid recurrence.
authors.affiliation: Assir Central Hospital, Abha, 61231, Kingdom of Saudi Arabia.
authors.forename: Nishith Kumar
authors.initials: NK
authors.lastname: Jetley
authors.affiliation: Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Kingdom of Saudi Arabia.
authors.forename: Ali Hassan
authors.initials: AH
authors.lastname: Al-Assiri
authors.affiliation: Assir Central Hospital, Abha, 61231, Kingdom of Saudi Arabia.
authors.forename: Abdulla S
authors.initials: AS
authors.lastname: Al-Helal
authors.affiliation: King Khalid University, Abha, 61413, Kingdom of Saudi Arabia.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Al-Bin Ali
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004314:Down Syndrome / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors