Intra pericardial herniation in congenital diaphragmatic hernia

Intrapericardial diaphragmatic hernia is a rare condition with only few cases reported in the English language literature.1 During a span of eight months in 2010-2011 we treated two cases of congenital intra pericardial diaphragmatic hernia in Royal Hospital in the Sultanate of Oman. The first case was not diagnosed antenatally as diaphragmatic hernia. Post-natally the neonate was diagnosed as having pericardial effusion and correct diagnosis arrived at by CTs can. The second case was diagnosed by antenatal scan as diaphragmatic hernia and confirmed in postnatal period by chest X-Ray as left congenital diaphragmatic hernia but intra-operative finding was an anterior diaphragmatic hernia with intra pericardial herniation of the liver and part of the bowel into the pericardial sac. Both neonates were intubated after birth due to respiratory distress. A polytetrafluoroethylene (PTFE) patch was used for repair of the defect in first case and the second case was repaired without a patch. In both cases, apart from the defect, the rest of the diaphragm, on either side, was intact; sac was absent and a pericardial defect was present. Both neonates were discharged in good condition.