Diaphragmatic hernia of Morgagni-Larrey in adults: analysis of 10 cases

Congenital diaphragmatic hernia of Morgagni-Larrey is a rare entity that usually presents on the right side. These hernias, occurring in the anterior midline through the sternocostal hiatus of the diaphragm, are usually discovered incidentally when the patient has reached adulthood, or when they become symptomatic due to intestinal involvement (occlusive symptoms) or when respiratory dysfunction occurs. We present 10 patients (mean age: 69 years) with symptomatic sternocostal hernia and intestinal occlusion. In 7 patients, the hernia was located on the right (Morgagni's hernia) and in three it was located on the left (Larrey's hernia). Most of the patients presented important associated comorbidity, mainly cardiovascular and neoplastic. Surgical treatment consisted of reduction of the contents of the herniated sac and hernia repair through simple suture with or without mesh for reinforcement, mainly through the abdominal approach. Mortality in this series was nil. The infrequency of this entity and its diagnosis mainly in adults, with a high prevalence of circumstances favoring abdominal hernias, suggest that an embryological defect of the sternocostal foramina of Morgagni or Larrey are an essential element in the physiopathology of these processes.     

Diaphragmatic hernia with extrathoracic heart

We report the cross sectional ultrasonic diagnosis of a rare form of central diaphragmatic hernia. The inferior portion of the parietal pericardium was also absent, with herniation of the heart through the defect. Surgical repair was successfully undertaken based on the ultrasonic findings.     

Diaphragmatic hernia after minimally invasive esophagectomy

Diaphragmatic hernia is an uncommon complication that can follow transhiatal esophagectomy. It has not been reported after minimally invasive esophagectomy. We report such a case presenting with features of small bowel obstruction. The paucity of adhesions following the combined laparoscopic and thoracoscopic approach may confer an increased risk of this complication.     

Papillary fibroelastoma. Report of 3 cases

Papillary fibroelastoma is a rare, benign, primary cardiac tumour. The authors report three cases presenting with transient or full cerebrovascular accidents. The tumours were diagnosed during investigation by echocardiography, especially transoesophageal echocardiography. In view of the severity of symptoms and the high risk of recurrence, the patients were rapidly referred for surgery. In two cases, the tumour was located on the aortic valve at several sites. In one case, the tumour was single and implanted on the mitral valve. Surgery was successful with the pathology reports confirming complete ablation. The patients have not had any recurrence to date. The multiple nature of these tumours raises the questions of local spread, secondary degeneration of valvular nodes? The problem of possible recurrences is discussed.     

Para-stomal hernias. Report of 3 cases

Three cases of stomal hernia are presented in this article; two females and one in male patient, the first two cases with colostomy and the remaining patient with ileostomy. One case was treated by replacing stoma and subsequent hernioplasty. The additional two were treated with Leslie technique. To date, there have been no recurrences. Patients were followed for a median of 2 years. Although this complication is infrequent we recommend careful planning prior to performing a stoma, as well as determining the best anatomic site and use good surgical technique.     

Complex coronary angioplasty. Report of 3 cases

Although coronary angioplasty is currently applied to a wide variety of obstructive coronary artery lesions, its indications have been reduced to certain selected cases. We present three cases of complex coronary angioplasty: in the elderly patient, after bypass surgery, and multiple lesions in one vessel comment about different causes that justify its use. We conclude emphasizing that currently percutaneous coronary angioplasty is a secure and successful alternative of treatment even in complex cases, if they are properly selected.