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Ağalar C, Atila K, Arslan NÇ, Derici ZS, Bora S. Adult morgagni hernia: a single center experience of 5 cases and review of literature. Turk J Surg 2019; 35:321-324. [PMID: 32551430 DOI: 10.5578/turkjsurg.3929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
Morgagni hernia is a rare congenital anomaly arising through the fusion defect between the septum transversum and sternum. Diagnosis is usually confusing as the presentation may be asymptomatic as well as with respiratory symptoms, abdominal and/or retrosternal pain, abdominal fullness or gastrointestinal obstruction. In this paper, we discussed the clinical presentation and management of this rare situation with five consecutive cases. Between 2009 and 2015, five cases underwent surgery for Morgagni hernia (3 laparoscopic and 2 open repair); one patient had recurrent hernia after 7 months from laparoscopic surgery. This case is the first recurrence in the literature after laparoscopic repair in an adult group. In Morgagni hernias, the only treatment is surgery, which can be performed by transthoracic, transabdominal, laparoscopic or thoracoscopic approaches. The issues of using mesh and reducing the hernia sac are still controversial.
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Affiliation(s)
- Cihan Ağalar
- Department of General Surgery, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Koray Atila
- Department of General Surgery, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Naciye Çiğdem Arslan
- Department of General Surgery, Istinye University School of Medicine, Istanbul, Turkey
| | - Zekai Serhan Derici
- Department of General Surgery, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Seymen Bora
- Department of General Surgery, Dokuz Eylul University School of Medicine, İzmir, Turkey
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Kumar A, Bhandari RS. Morgagni hernia presenting as gastric outlet obstruction in an elderly male. J Surg Case Rep 2016; 2016:rjw126. [PMID: 27432902 PMCID: PMC4948761 DOI: 10.1093/jscr/rjw126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Morgagni hernia is the rarest of all congenital diaphragmatic hernias, first described in 1769. It is rarely symptomatic and found on routine radiological examinations for other conditions. Gastric outlet obstruction in adults with Morgagni Hernia is exceedingly rare. An 80-year-old man was taken to the operating room with a diagnosis of Morgagni hernia with gastric outlet obstruction. An upper midline laparotomy was performed, and the incarcerated pylorus and antrum of the stomach reduced with primary closure of the defect. Postoperative period was uneventful, and the patient was discharged on the sixth postoperative day. Morgagni hernia is exceedingly rare in adults and may present with gastric outlet obstruction in the emergency room. This clinical entity should be kept in mind while evaluating the patient, and early surgical intervention should be initiated.
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Affiliation(s)
- A Kumar
- Department of Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - R S Bhandari
- Department of Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Kathmandu, Nepal
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Tone K, Kiryu I, Yoshida M, Tsuboi K, Takagi M, Kuwano K. Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: a case report and overview of the literature. Respir Investig 2014; 52:203-8. [PMID: 24853023 DOI: 10.1016/j.resinv.2013.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 09/13/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022]
Abstract
An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.
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Affiliation(s)
- Kazuya Tone
- Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan; Department of Internal Medicine, Respiratory Division, Jikei University School of Medicine, Tokyo, Japan.
| | - Ikumi Kiryu
- Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan.
| | - Masahiro Yoshida
- Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan.
| | - Kazuto Tsuboi
- Department of Surgery, Kashiwa Hospital, Chiba, Japan.
| | - Masamichi Takagi
- Department of Respiratory Medicine, Kashiwa Hospital, Chiba, Japan.
| | - Kazuyoshi Kuwano
- Department of Internal Medicine, Respiratory Division, Jikei University School of Medicine, Tokyo, Japan.
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Türüt H, Demirpolat G, Bülbüloglu E, Yüksel M. Life-Threatening Vomiting Caused by Large Morgagni Hernia in an Octogenarian. Asian Cardiovasc Thorac Ann 2008; 16:240-1. [DOI: 10.1177/021849230801600313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 84-year-old woman presented with frequent severe vomiting, dyspnea and generalized muscle weakness associated with diaphragmatic hernia. Her poor general condition and muscle weakness resembling cranial pathology were considered to be due to severe vomiting caused by a Morgagni hernia. An urgent subcostal laparotomy confirmed the diagnosis. The critical role of urgent surgery, even in advanced age, is emphasized.
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Affiliation(s)
| | - Gülen Demirpolat
- Department of Radiology, Kahramanmaras Sutcu Imam University, School of Medicine, Kahramanmaras, Turkey
| | - Ertan Bülbüloglu
- Department of General Surgery, Kahramanmaras Sutcu Imam University, School of Medicine, Kahramanmaras, Turkey
| | - Mürüvvet Yüksel
- Department of Radiology, Kahramanmaras Sutcu Imam University, School of Medicine, Kahramanmaras, Turkey
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Yilmaz M, Isik B, Coban S, Sogutlu G, Ara C, Kirimlioglu V, Yilmaz S, Kayaalp C. Transabdominal approach in the surgical management of Morgagni hernia. Surg Today 2007; 37:9-13. [PMID: 17186338 DOI: 10.1007/s00595-006-3336-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 07/25/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE Morgagni hernias are uncommon diaphragmatic hernias that are generally asymptomatic, and so far only limited data have been reported. The objective of this retrospective study was to evaluate the outcome of patients presenting with a complicated Morgagni hernia and who undergo a transabdominal repair. METHODS Between September 1999 and October 2005, 11 patients with Morgagni hernia were operated on in our department. Eight of them had acute presentations because of a complicated Morgagni hernia. The patient demographics, presenting symptoms, operative approach, and complications were collected. The postoperative course was evaluated for morbidity and mortality. RESULTS The patients' ages ranged from 42 to 85 years (mean 69.4). Two (18.2%) patients were male and nine (81.8%) patients were female. Chest roentgenograms, computed tomography, and contrast meal studies were used as diagnostic utilities. A transabdominal approach was used for all patients. One patient died due to pulmonary failure. The mean follow-up was 2.8 years. There was no recurrence or symptoms regarding the operation in the remaining patients. CONCLUSION We recommend the transabdominal approach in patients with Morgagni hernia as it makes it easy to reduce the hernia contents and repair of the hernia sac. Moreover, when complicated with strangulation, incarceration or perforation, a surgical repair through a transabdominal approach is mandatory.
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Affiliation(s)
- Mehmet Yilmaz
- Department of General Surgery, School of Medicine, Inonu University, Turgut Ozal Medical Center, 44069 Malatya, Turkey
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Dapri G, Himpens J, Hainaux B, Roman A, Stevens E, Capelluto E, Germay O, Cadière GB. Surgical technique and complications during laparoscopic repair of diaphragmatic hernias. Hernia 2006; 11:179-83. [PMID: 17131071 DOI: 10.1007/s10029-006-0161-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Abstract
Diaphragmatic hernias can present as retrocostoxiphoid hernias (RCXH) or diaphragmatic dome hernias. The RCXH include the Larrey hernia (LH), the Morgagni hernia (MH), and the Larrey-Morgagni hernia (LMH). These congenital hernias are usually asymptomatic, and the diagnosis is simplified by two exams: chest X-ray, and thoraco-abdominal computed tomography (CT) scan. The potential risk in this condition is small-bowel incarceration in the hernia defect and subsequent obstruction. We report two cases of LH and one case of LMH treated by laparoscopy between February 2004 and October 2005, with a review of the surgical techniques. Two different laparoscopic techniques were used: the tension-free technique, and resection of the hernia sac with closure of the defect and reinforcement by prosthesis. One patient presented a postoperative cardiac tamponade due to a clip-induced bleeding of an epicardial artery at the inferior surface of the heart. Treatment by laparoscopy is feasible, but a consensus regarding the best laparoscopic repair is needed.
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Affiliation(s)
- G Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
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Vañó Sanchís D, Arranz García G, Sánchez-Manjavacas Muñoz N. Hernia diafragmática de Morgagni en el adulto. Rev Clin Esp 2006; 206:468-9. [PMID: 17042998 DOI: 10.1157/13093484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Oakes SL, Espino DV, Santana N, Carcamo GE. MORGAGNI'S HERNIA IN AN OLDER ADULT WOMAN WITH A SUBPHRENIC ABSCESS. J Am Geriatr Soc 2006; 54:1153-4. [PMID: 16866699 DOI: 10.1111/j.1532-5415.2006.00778.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Akhavan-Heidari M, Edwards D, Besenhaver J, Wolfer R. Incidental Finding of Congenital Thoracic Malformations in Adult Population. South Med J 2006; 99:539-43. [PMID: 16711323 DOI: 10.1097/01.smj.0000216467.71377.fe] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluation of abnormal adult chest computed tomography (CT) scans. STUDY DESIGN Retrospective series of 3 cases. SETTING Two University-based hospitals. INTERVENTION Three adult patients (age range 56 to 61) underwent chest CT scans. Two were trauma patients and one complained of chest pain with a negative cardiac workup. One CT scan revealed a lung mass that was highly suspicious for malignancy and the other two CT scans were suspicious for diaphragmatic hernia. Two patients underwent elective surgery and the third underwent emergent surgery. RESULTS The CT scan of patient 1 was suspicious for malignancy; however, the pathology of the lung mass revealed only inflammation consistent with an intralobular bronchopulmonary sequestration. Patient 2 had a congenital Morgagni hernia with omentum and colon in the mediastinum, and patient 3 had a diaphragmatic defect combined with a bifid sternum and defective pericardium, fulfilling three criteria of pentalogy of Cantrell. CONCLUSION Thoracic congenital malformations may go unnoticed and unsuspected until adulthood. They should be kept in mind when reviewing unusual CT scans of the chest in adults. Their surgical management, however, is similar to their counterparts in infancy.
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Barut I, Tarhan OR, Cerci C, Akdeniz Y, Bulbul M. Intestinal Obstruction Caused by a Strangulated Morgagni Hernia in an Adult Patient. J Thorac Imaging 2005; 20:220-2. [PMID: 16077338 DOI: 10.1097/01.rti.0000154078.59689.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.
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Affiliation(s)
- Ibrahim Barut
- Suleyman Demirel University, School of Medicine, Department of General Surgery, Isparta, Turkey.
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Rodríguez Hermosa JI, Tuca Rodríguez F, Ruiz Feliu B, Gironès Vilà J, Roig García J, Codina Cazador A, Figa Francesch M, Acero Fernández D. [Diaphragmatic hernia of Morgagni-Larrey in adults: analysis of 10 cases]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 26:535-40. [PMID: 14642239 DOI: 10.1016/s0210-5705(03)70408-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- J I Rodríguez Hermosa
- Unidad Médico-Quirúrgica Digestiva, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Dr Josep Trueta, Girona, España
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12
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Thoman DS, Hui T, Phillips EH. Laparoscopic diaphragmatic hernia repair. Surg Endosc 2002; 16:1345-9. [PMID: 11984662 DOI: 10.1007/s00464-001-8162-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2001] [Accepted: 01/07/2002] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adult-congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias are uncommon entities that are often technically challenging to repair. There is growing experience with a minimal access approach to these defects. METHODS We reviewed the English-language literature using a MEDLINE search for "diaphragmatic hernia" and "laparoscopy." RESULTS We found 19 case reports of laparoscopic adult-congenital diaphragmatic hernia repair. Reported complications included two enterotomies, one of which required conversion to laparotomy. We also found 11 case reports of laparoscopic chronic traumatic diaphragmatic hernia repair, with no reported complications or recurrences. Average operative time was 98 min, and average length of stay was 4.5 days. All reports claimed that there was less postoperative pain and an earlier return to full activity with the laparoscopic approach. Herein we discuss anatomy, pathophysiology, diagnosis, method of repair, and recurrence. CONCLUSION Adult-congenital diaphragmatic hernia and chronic traumatic diaphragmatic hernia are amenable to laparoscopic repair. Although experience is still limited, laparoscopic repair appears safe and is associated with a shorter hospital stay.
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Affiliation(s)
- D S Thoman
- Division of Minimally Invasive Surgery, Cedars-Sinai Medical Centre, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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Echenique M, Amondarain JA, Marc B. Hernias de Morgagni. Presentación de una serie de casos tratados en la era prelaparoscópica. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71960-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lev-Chelouche D, Ravid A, Michowitz M, Klausner JM, Kluger Y. Morgagni hernia: unique presentations in elderly patients. J Clin Gastroenterol 1999; 28:81-2. [PMID: 9916677 DOI: 10.1097/00004836-199901000-00022] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We present case reports of 2 patients who were admitted to our ward for complications of Morgagni hernias. Both patients were elderly. Morgagni hernia is a rare condition. Its unique and late presentation are presented and discussed.
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Affiliation(s)
- D Lev-Chelouche
- Department of Surgery B&C, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Del Castillo D, Sanchez J, Hernandez M, Sanchez A, Domenech J, Jara J. Morgagni's hernia resolved by laparoscopic surgery. J Laparoendosc Adv Surg Tech A 1998; 8:105-8. [PMID: 9617972 DOI: 10.1089/lap.1998.8.105] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Morgagni's hernias represent between 2 and 4% of the whole of nontraumatic diaphragmatic hernias in the adult, and the treatment (even with minimal symptoms) is always with surgery. We present the case of a 50-year-old woman with an oppressive, postprandial discomfort in the right side of her thorax and with increased pain when supine. The x-ray examination indicated a large portion of transverse colon inside the thoracic cavity. Once the diagnosis of Morgagni's hernia had been obtained, she was scheduled for laparoscopic surgery to reduce the hernia and to reconstruct the defect of the diaphragm using a polypropylene mesh.
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Affiliation(s)
- D Del Castillo
- Department of Surgery, University Hospital of St. Joan, Rovira i Virgili University School of Medicine and Health Sciences (C/Sant Joan s/n), Reus, Spain
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Abstract
Morgagni-type diaphragmatic hernias are rare. The overwhelming majority are discovered in children who usually present with pneumonia or sepsis. We report an unusual case of a 57-yr-old woman with a Morgagni hernia presenting with pulmonary symptoms. Complicating the clinical picture, the pneumonia delayed the definitive diagnosis until a lateral chest X-ray study revealed loops of bowel in the right lower lung fields. It is important to entertain abdominal etiologies in the differential diagnosis of a thoracic density.
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Affiliation(s)
- S T Lin
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center 90033, USA
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