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Postoperative Intestinal Obstruction Due to Morgagni Hernia in a Known Case of Anorectal Malformation in a Down's Syndrome Infant: A Rare Presentation
DR. MARIA SARFRAZ, DR. SHAHEER ABDULLAH, DR. SHABBIR HUSSAIN
Liaquat National Hospital
ABSTRACT
Introduction: Morgagni hernia is a rare form of congenital diaphragmatic hernia, accounting for approximately 1–5% of cases. While often asymptomatic and discovered incidentally, its prevalence is higher in individuals with Down's syndrome. Postoperative presentation leading to intestinal obstruction is exceptionally uncommon.
Case Presentation: An 8-month-old male infant with Down's syndrome was referred from Afghanistan for definitive surgical management of imperforate anus. He had previously undergone a sigmoid colostomy for a pouch colon during neonatal period. Preoperative imaging and echocardiography were unremarkable. The patient underwent exploratory laparotomy, pouch colon resection, ileostomy formation, and posterior sagittal anorectoplasty. The immediate postoperative course was uneventful; however, on the second postoperative day, he developed significant abdominal distension , tachypnea and increased nasogastric output. Radiographs indicated herniated bowel loops in chest. Conservative management failed to resolve the obstruction, necessitating reoperation. Intraoperatively, viable small bowel loops were found herniating through an anterior diaphragmatic defect consistent with a Morgagni hernia. The hernia was reduced, and the defect was repaired.
Discussion: This case highlights an atypical presentation of Morgagni hernia, undetected on initial imaging and becoming symptomatic only after major abdominal surgery. The delayed manifestation may be attributed to postoperative anatomical shifts and the inherent connective tissue fragility associated with Down's syndrome. Similar cases have been reported following cardiac or neurosurgical interventions, suggesting that surgical manipulation can unmask previously subclinical defects.In summary we have presented an unusual presentation of a Morgagni hernia manifesting as postoperative acute intestinal obstruction a patient of Down's syndrome.