Empleo de toxina botulínica en pared abdominal como tratamiento previo a la reparación quirúrgica de una hernia de Morgagni gigante

Abstract

IntroductionCongenital hernias of the diaphragm, such as giant Morgagni hernia, are rarely seen, both because of their low prevalence and also because they sometimes go unnoticed in childhood, producing symptoms later into adulthood. During the surgical repair of a large hernia of the diaphragm, reintroducing the hernia's contents in the abdominal cavity and closing the diaphragm orifice can lead to compressive symptoms, such as respiratory insufficiency or compartment syndrome, threatening patient's life. Case reportWe report the case of a 62-year-old obese woman with a giant Morgagni hernia that occupied 2/3 of the right side of the thorax. A computerized tomography of the chest, abdomen and pelvis revealed a large hernia (22.8×14.1×17.2cm) containing small bowel, and ascending and transverse colon. Before surgical repair of the hernia, botulinum toxin was injected in the abdominal wall to relax the muscles and increase the volume of the abdominal cavity for better accommodation of the returned hernial contents. Twenty-one days after treatment with the toxin, the volume of the abdominal cavity had expanded by 37% (5035 vs 6900ml).The patient was subsequently subjected to simple closure of the hernia defect through a right subcostal laparotomy. No complications were produced. ConclusionAfter treatment of this case, we consider the use of botulinum toxin is a good preventive measure against complications of diaphragmatic hernias (Morgagni), especially in large ones, where the return of the herniated contents could cause an acute compartment syndrome.