1
|
Pal NL, Panandiker SD, Katiyar G, Vernekar JA. Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist. Emerg Radiol 2024:10.1007/s10140-024-02256-8. [PMID: 38926239 DOI: 10.1007/s10140-024-02256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
Collapse
Affiliation(s)
- Nilkanth L Pal
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India.
| | - Swamini D Panandiker
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Glory Katiyar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Jeevan A Vernekar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| |
Collapse
|
2
|
Schembari E, Reitano E, Sofia M, Latteri S, La Greca G. The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair. Updates Surg 2024; 76:839-844. [PMID: 37924436 PMCID: PMC11130068 DOI: 10.1007/s13304-023-01677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/07/2023] [Indexed: 11/06/2023]
Abstract
A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.
Collapse
Affiliation(s)
| | - Elisa Reitano
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Maria Sofia
- General Surgery, Cannizzaro Hospital, Catania, Italy
| | - Saverio Latteri
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gaetano La Greca
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| |
Collapse
|
3
|
Mansour M, Ismail A, Alfathi M, Alsuliman T, Ismail A. Use of the transabdominal approach to repair Morgagni hernia in a 28-year-old symptomatic female: A case report. Clin Case Rep 2022; 10:e05657. [PMID: 35356181 PMCID: PMC8956857 DOI: 10.1002/ccr3.5657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Morgagni's hernia is a congenital diaphragmatic hernia, which represents only 3% of all diaphragmatic hernias. Herein, we report a case of a 28-year-old symptomatic female patient with Morgagni's hernia who underwent a transabdominal surgery for hernia repair and mesh placement.
Collapse
Affiliation(s)
- Marah Mansour
- Faculty of MedicineTartous UniversityTartousSyrian Arab Republic
| | - Ammar Ismail
- Faculty of MedicineTartous UniversityTartousSyrian Arab Republic
| | - Maria Alfathi
- Faculty of MedicineDamascus UniversityDamascusSyrian Arab Republic
| | - Tamim Alsuliman
- Hematology and Cell Therapy DepartmentSaint‐Antoine HospitalAP‐HPSorbonne UniversityParisFrance
| | - Adnan Ismail
- Department of Thoracic SurgeryKalamoon University HospitalDamascusSyrian Arab Republic
| |
Collapse
|
4
|
Perforated Appendicitis and Bowel Incarceration within Morgagni Hernia: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57020089. [PMID: 33494223 PMCID: PMC7909783 DOI: 10.3390/medicina57020089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
Morgagni hernia (MH) is a result of abdominal organ protrusion through the congenital defect in the anterior retrosternal aspect of the diaphragm. The colon and omentum are the most commonly involved organs, followed by the small intestine, stomach and liver. Symptoms of MH may be absent, although the majority of patients will experience mild dyspnea or abdominal discomfort. We present a case of MH complicated with intrathoracic acute perforated appendicitis and intestinal obstruction.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Hashmi MU, Ullah K, Tariq A, Sarwar M, Khan IH. Morgagni-Larrey Hernia: A Possible Cause of Recurrent Lower Respiratory Tract Infections. Cureus 2019; 11:e4035. [PMID: 32181060 PMCID: PMC7053801 DOI: 10.7759/cureus.4035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Morgagni-Larrey hernia is an exceedingly rare presentation of congenital diaphragmatic hernia. Despite its rarity, it is associated with significant risk of morbidity and mortality. Herein, we describe a unique case report of an elderly woman who presented with left-sided chest pain, dyspnea, and chronic history of recurrent respiratory tract infections. On the basis of her medical history, general physical examination and imaging studies, she was operated for a presumptive diagnosis of thymolipoma. However, the intra-operative findings revealed that it was an unusual variant of a diaphragmatic hernia and the hernia sac appeared through the retrosternal foramen of Morgagni. Hence we concluded that it was a Morgagni-Larrey hernia compressing the lungs and heart. Consequently, the hernia was reduced and the defect was repaired. During the postoperative period, the patient had an uneventful recovery. To conclude, the possibility of a Morgagni-Larrey hernia should be strongly considered while evaluating a patient with recurrent chest infections, dyspnea, and vague chest pain.
Collapse
Affiliation(s)
| | - Kaleem Ullah
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Ayesha Tariq
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Mohsin Sarwar
- Internal Medicine, Shifa College of Medicine, Islamabad, PAK
| | - Iftikhar H Khan
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| |
Collapse
|
7
|
Tan YW, Banerjee D, Cross KM, De Coppi P, Blackburn SC, Rees CM, Giuliani S, Curry JI, Eaton S. Morgagni hernia repair in children over two decades: Institutional experience, systematic review, and meta-analysis of 296 patients. J Pediatr Surg 2018; 53:1883-1889. [PMID: 29776739 DOI: 10.1016/j.jpedsurg.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE Morgagni diaphragmatic hernia (MH) is rare. We report our experience based on routine patch use in MH repair to curb recurrence. A systematic review and meta-analysis were performed to study the recurrence and complications associated with minimally invasive surgery and the use of patch. METHODS We retrospectively reviewed all cases of MH who underwent first-time repair in 2012-2017 in our institution to determine recurrence and complication rate. A MEDLINE search related to minimally invasive surgery (MIS) and patch repair of MH was conducted for systematic review. Eligible articles published from 1997-2017 with follow-up data available were included. Primary outcomes measured were recurrence and complication. Meta-analysis to compare open versus MIS and primary versus patch repair in the MIS group were performed in comparative cohorts. Continuous data were presented as median (range), and statistical significance was P<0.05. RESULTS In our institution, 12 consecutive patients aged 17-month-old (22 days-7 years), underwent laparoscopic patch repair of MH, with one conversion to laparotomy. No recurrence or significant complication occurred over a follow-up period of 8 months (1-48 months). Thirty-six articles were included from literature review and were combined with the current series. All were retrospective case reports or series, of which 6 were comparative cohorts with both MIS and open repairs. A total of 296 patients from 37 series were ultimately used for analysis: 80 had open repair (4 patch) and 216 had MIS repair (32 patch), with a patch rate of 12%. There were 13 recurrences (4%): no difference between open and MIS repairs (4/80 vs 9/216, p=0.75); recurrence rate following primary repair was 13/260 (5%), but no recurrence occurred with 36 patch repairs. Meta-analysis showed no difference in recurrence between open and MIS repair (p=0.83), whereas patch repair was associated with 14% less recurrence compared with primary repair, although it did not reach statistical significance (p=0.12). There were 13 complications (5%): no difference between open and MIS repairs (5/80 vs 8/216, p=0.35). One small bowel obstruction occurred in a patient who had laparoscopic patch repair. CONCLUSION In MH, recurrence and complication rates are comparable between MIS and open repairs. Use of patch appeared to confer additional benefit in reducing recurrence. TYPE OF STUDY Systematic review LEVEL OF EVIDENCE: 3A.
Collapse
Affiliation(s)
- Yew-Wei Tan
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Debasish Banerjee
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK; Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK.
| | | | - Simon C Blackburn
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Clare M Rees
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Joe I Curry
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department, Great Ormond Street Hospital, London, UK
| | - Simon Eaton
- Stem Cells & Regenerative Medicine, DBC, Great Ormond Street Institute of Child Health, University College London, UK
| |
Collapse
|
8
|
Abstract
AIM To clarify the indications for reconstructive surgery in patients with diaphragmatic hernia. MATERIAL AND METHODS Retrospective trial has included 36 patients with diaphragmatic hernia for the period 1963-2017. There were 23 (63.9%) women and 13 (36.1%) men. The majority of patients (83%) underwent surgery at able-bodied age (18-60 years). 27 (75%) patients had hernia of weak diaphragmatic zones, 9 (25%) - posttraumatic hernia. Diaphragm repair was performed with primary suture. In 2 cases of posttraumatic hernia mesh endoprosthesis was used. RESULTS All patients were discharged. Postoperative complications arose in 4 (11.1%) patients, including 2 cases of mesh endoprosthesis deployment. Long-term outcome was followed-up in 15 patients from 6 months to 17 years. Recurrent hernia was absent in all cases. CONCLUSION Primary suture is acceptable for diaphragmatic hernia repair. Alloplastic repair is indicated for large defect, when primary suture is impossible or risk of its failure is high.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Khetagurov
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
9
|
Zhao H, Gao R, Jia D, Li A. Delayed traumatic parasternal hernia causes jejunal necrosis: A case report. Trauma Case Rep 2018; 9:30-33. [PMID: 29644321 PMCID: PMC5883187 DOI: 10.1016/j.tcr.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2017] [Indexed: 11/26/2022] Open
Abstract
Diaphragmatic injury is a common clinical condition, and it may be difficult to avoid diaphragmatic hernia if detection and treatment is not timely. Parasternal hernia is mostly congenital. It is relatively rare in adults, and intestinal obstruction as a complication of intrathoracic intestinal herniation occurs only rarely. We treated a patient in whom parasternal hernia occurred 2 years after thoracic injuries. We present the plain radiography and computed tomography findings of this adult patient with acute abdomen symptoms caused by parasternal hernia.
Collapse
Affiliation(s)
- Huimin Zhao
- Department of Thoracic Surgery, No. 1 Hospital of BaoDing City, China
| | - Ru Gao
- Department of Thoracic Surgery, No. 1 Hospital of BaoDing City, China
| | - Donghui Jia
- Department of Thoracic Surgery, No. 1 Hospital of BaoDing City, China
| | - Aiming Li
- Department of Thoracic Surgery, No. 1 Hospital of BaoDing City, China
| |
Collapse
|
10
|
Navarro-Sánchez A, López-Fernández J, Hernández-Hernández JR. Left lobe of liver in a Morgagni's hernia. ANZ J Surg 2017; 89:257-258. [PMID: 28503787 DOI: 10.1111/ans.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/12/2016] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Antonio Navarro-Sánchez
- Department of General Surgery, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José López-Fernández
- Department of General Surgery, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | |
Collapse
|
11
|
Strangulated Morgagni's Hernia: A Rare Diagnosis and Management. Case Rep Surg 2016; 2016:2621383. [PMID: 27891284 PMCID: PMC5116526 DOI: 10.1155/2016/2621383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/19/2016] [Indexed: 12/05/2022] Open
Abstract
Morgagni hernia is a rare type of congenital diaphragmatic hernia. It accounts for only 3% of all diaphragmatic hernias. The defect is small and hernia being asymptomatic in the majority presents late in adulthood. Obstruction or incarceration in Morgagni hernia is uncommon. We report a rare occurrence of strangulated Morgagni hernia. A 40-year-old gentleman presented to our emergency department with features of intestinal obstruction. Computed tomography of the chest and abdomen showed a strangulated right Morgagni hernia. An exploratory laparotomy was performed with resection of the ischemic bowel segment with anastomosis and a primary repair of the diaphragmatic defect. Postoperative recovery was uneventful and asymptomatic at follow-up.
Collapse
|
12
|
Slepov O, Kurinnyi S, Ponomarenko O, Migur M. Congenital retrosternal hernias of Morgagni: Manifestation and treatment in children. Afr J Paediatr Surg 2016; 13:57-62. [PMID: 27251653 PMCID: PMC4955447 DOI: 10.4103/0189-6725.182557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Due to scarcity of congenital diaphragmatic hearnias of Morgagni (CDHM), non-specific clinical presentation in the pediatric age group, we aimed to investigate the incidence, clinical manifestations, anatomical characteristics, and develop diagnostic algorithm and treatment of CDHM in children. MATERIALS AND METHODS The patients' records of children with CDHM treated in our hospital during past 20 years were retrospectively reviewed for the age at diagnosis, gender, clinical findings, anatomical features, operative details and outcome. RESULTS Since 1995 to 2014 we observed 6 (3 boys, 3 girls) patients with CDHM, that comprise 3.2% of all congenital diaphragmatic hernia cases (n = 185). Age at diagnosis varied from 3 mo. to 10y.o. Failure to thrive was main symptom in 4 patients, followed by recurrent respiratory infections (n = 3), dyspnea (n = 3), and gastrointestinal manifestations: constipation (n = 2), abdominal pain (n = 1). Work-up consisted of plain X-ray for all (n = 6), upper GI (n = 3), barium enema (n = 2), sonography (n = 6) and CT (n = 2). Abdominal approach used in 5 patients, and thoracotomy in one. Herniated contents were: liver lobes (n = 4), transverse colon (n = 3) and greater omentum (n = 1). 5 had right-sided lesion, 1- left-sided. Defect repaired using local tissues. Post-operative course was uneventful; all patients appeared well during follow-up. CONCLUSION CDHM is very uncommon anomaly, very occasionally diagnosed at the early age. Failure to thrive and recurrent respiratory infections are most frequent clinical manifestations. In suspected CDHM we advocate the following work-up: plain chest and abdominal X-ray, contrast study (upper GI series or barium enema), ultrasonographic screen and CT scan. Surgical repair via abdominal approach, using local tissues and hernia sac removal is preferred.
Collapse
Affiliation(s)
- Oleksii Slepov
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Sergii Kurinnyi
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Oleksii Ponomarenko
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| | - Mikhailo Migur
- Department of Pediatric Surgery, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine
| |
Collapse
|
13
|
|
14
|
Abstract
Surgical repair of Morgagni hernias is recommended given their historically high risk of incarceration. Traditionally, such repair has been undertaken via laparotomy or thoracotomy or more recently, thoracoscopically or laparoscopically using mesh. Here, we describe a laparoscopic approach to the management of Morgagni hernias achieving a primary tissue repair without mesh implantation. This technique allows for the general benefits of minimally invasive surgery, such as less postoperative pain, reduced wound complications, decreased duration of the hospital stay, as well as offering an alternative to mesh implantation and its associated potential complications.
Collapse
|
15
|
Mambo NC. Nontraumatic Liver Herniation through a Right–Sided Congenital Diaphragmatic Hernia of Morgagni: An Autopsy Case Report with a Review of Liver Herniations through the Defect and a Review of the Defect. Acad Forensic Pathol 2014. [DOI: 10.23907/2014.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Congenital diaphragmatic hernia of Morgagni (CMH) is a rare developmental defect that develops during the development of the human diaphragm. It is usually right-sided and tends to produce symptoms in later life when abdominal viscera herniate into the chest cavities. Herniations of the liver through this defect into the chest cavities are rare and are often not clinically suspected even when they are associated with symptoms. The amounts of liver tissue involved are usually small, do not cause symptoms and are often an incidental finding during imaging studies of the chest for unrelated symptoms. This case report documents a clinically unrecognized incidental herniation of the liver into the right chest cavity through a CMH. The report also reviews previously reported cases of liver herniations through a CMH and the possible causes of the defect.
Collapse
Affiliation(s)
- Nobby C. Mambo
- Galveston County, Texas City, TX, and University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
16
|
|
17
|
Nenekidis I, Anagnostakou V, Zisis C, Prokakis C, Koletsis EN, Apostolakis E, Dedeilias P. Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis. J Cardiothorac Surg 2011; 6:30. [PMID: 21401951 PMCID: PMC3065407 DOI: 10.1186/1749-8090-6-30] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 03/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foramen of Morgagni hernias have traditionally been repaired by laparotomy, laparoscopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases. CASE PRESENTATION We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion. CONCLUSIONS Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.
Collapse
Affiliation(s)
- Ioannis Nenekidis
- 1st Cardiac Surgery Department, Evangelismos Hospital, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
18
|
Papanikolaou V, Giakoustidis D, Margari P, Ouzounidis N, Antoniadis N, Giakoustidis A, Kardasis D, Takoudas D. Bilateral Morgagni Hernia: Primary Repair without a Mesh. Case Rep Gastroenterol 2008; 2:232-7. [PMID: 21490893 PMCID: PMC3075148 DOI: 10.1159/000142371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We present a case of bilateral Morgagni hernia in a 68-year-old male with an intermittent history of progressive onset of breath shortness and occasional cardiac arrhythmias. Diagnosis was made by clinical examination and the findings in a plain chest radiograph and was confirmed by computed tomography scan. The patient was operated electively and subjected to a transabdominal approach. A bilateral subcostal incision revealed a large right side anterior diaphragmatic defect with a hernia containing the ascending colon, the majority of the transverse colon and a huge amount of omentum. Also a second smaller defect was found on the left side with no hernia inside. After large bowel and omentum had been taken down to the peritoneal cavity, both defects were primarily closed using interrupted nylon sutures without the use of a mesh. The patient recovered very well, had an uneventful postoperative course and was released on the 5th postoperative day. 15-month follow-up failed to reveal any signs of recurrence.
Collapse
Affiliation(s)
- Vassilios Papanikolaou
- Department of Transplant Surgery, Medical School, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Pauwels FF, Hawkins JF, MacHarg MA, Rothenbuhler RD, Baird DK, Moulton JS. Congenital retrosternal (Morgagni) diaphragmatic hernias in three horses. J Am Vet Med Assoc 2007; 231:427-32. [PMID: 17669046 DOI: 10.2460/javma.231.3.427] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 3 Horses were examined and treated because of sudden onset of signs of abdominal pain. CLINICAL FINDINGS All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac. TREATMENT AND OUTCOME Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correction, no major postoperative complications developed, and all 3 horses have been free of signs of abdominal pain. CLINICAL RELEVANCE Horses with retrosternal hernias involving the diaphragm can develop clinical signs of intermittent obstruction of the large colon and chronic colic. In horses, retrosternal diaphragmatic hernias appear to develop exclusively in the right ventral aspect of the diaphragm and could represent an embryologic defect of diaphragm formation. Affected horses can be successfully treated with mesh herniorrhaphy or, in some instances, with conservative management.
Collapse
Affiliation(s)
- Frederik F Pauwels
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN 47907, USA
| | | | | | | | | | | |
Collapse
|
20
|
Losanoff JE, Richman BW, Jones JW. Morgagni hernia and colonic malrotation in an adult. Int J Clin Pract 2007; 61:692-4. [PMID: 17394442 DOI: 10.1111/j.1742-1241.2006.01083.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
21
|
Ambrogi V, Forcella D, Gatti A, Vanni G, Mineo TC. Transthoracic repair of Morgagni's hernia: a 20-year experience from open to video-assisted approach. Surg Endosc 2006; 21:587-91. [PMID: 17180292 DOI: 10.1007/s00464-006-9017-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 06/19/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Foramen of Morgagni's hernia is an uncommon congenital diaphragmatic hernia. Repair is mostly performed through laparotomy. We prefer the transthoracic approach, which allows better and safer control during thoracic dissection, although it is considered more painful and related to greater morbidity. In recent years we introduced the transxiphoid hand-assisted videothoracoscopic approach, which combines the advantages of the thoracic route with a mini-invasive procedure facilitated by one hand inside the chest. METHODS A retrospective review was performed over a 20-year period (1985-2005). Twenty-two patients who had a foramen of Morgagni's hernia repaired were identified and relevant data were collected. Average age was 57 +/- 10 years and one half of the patients were asymptomatic. Chest roentgenograms, chest computerized tomography, and barium enema were used as diagnostic utilities. Posterolateral thoracotomy was performed in 17 (15 right-sided) patients, whereas in 5 (all right-sided) the defect was repaired by transxiphoid hand-assisted videothoracoscopy. Operative time, pain scored by visual analog scale, hospital stay, and cosmetic results by acceptance score were reviewed for every patient. RESULTS Hernial sac was present in all cases and contained only omentum (n = 13), omentum plus transverse colon (n = 7), omentum plus transverse colon and small bowel (n = 2). In 6 patients (2 videothoracoscopy) we repaired the large defects with polypropylene mesh. Videothoracoscopy achieved significant good results compared to thoracotomy in operative time (85 +/- 7.9 versus 110 +/- 11.3 min, p < 0.01), 24-h visual analog scale (3.5 +/- 1.1 versus 6.7 +/- 3.9, p < 0.01), hospital stay (2.6 +/- 0.5 versus 6.4 +/- 1.2 days, p < 0.01), and acceptance score (4.3 +/- 0.5 versus 3.1 +/- 0.8, p < 0.05). Postoperative course was always uneventful. Patients were followed for an average period of 58.6 +/- 14.7 and 109.7 +/- 43.5 months, respectively: no recurrences were found in any group. CONCLUSIONS We believe that the transthoracic approach is a safe and effective method for repairing Morgagni's hernia. The videothoracoscopic approach is a promising alternative and it may be facilitated by introducing a hand inside the chest.
Collapse
Affiliation(s)
- V Ambrogi
- Department of Thoracic Surgery, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy.
| | | | | | | | | |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Ibrahim Barut
- Suleyman Demirel University, School of Medicine, Department of General Surgery, Isparta, Turkey.
| | | | | | | | | |
Collapse
|
23
|
Abstract
A 77 year old woman who presented with an incarcerated hernia of Morgagni was successfully treated without complications. A Medline search (1996 to date) along with cross referencing was done to quantify the number of acute presentations in adults compared to children. Different investigating modalities--for example, lateral chest and abdominal radiography, contrast studies or, in difficult cases, computed tomography or magnetic resonance imaging--can be used to diagnose hernia of Morgagni. The favoured method of repair--laparotomy or laparoscopy--is also discussed. A total of 47 case reports on children and 93 case reports on adults were found. Fourteen percent of children (seven out of 47) presented acutely compared with 12% of adults (12 out of 93). Repair at laparotomy was the method of choice but if uncertain, laparoscopy would be a useful diagnostic tool before attempted repair. Laparoscopic repair was favoured in adults especially in non-acute cases.
Collapse
Affiliation(s)
- T P F Loong
- Tumour Biology Laboratory, Bart's and the London Queen Mary's School of Medicine and Dentistry, John Vane Science Centre, Charterhouse Square, London ECIM 6BQ, UK
| | | |
Collapse
|
24
|
Abstract
OBJECTIVE Morgagni's hernia is a relatively uncommon diaphragmatic hernia with a potential for considerable morbidity, if the diagnosis is delayed or missed. This review of cases of Morgagni's hernia was undertaken in order to emphasize methods of diagnosis and treatment. METHODS From 1992 through 2002, seven patients with Morgagni's hernia (5 right, 2 left) were surgically treated at our hospital. We investigated the patients preoperatively including chest roentgenogram, chest CT scan, and contrast studies of the upper gastrointestinal tract. Operative repair was accomplished with the transabdominal or transthoracic approach. Basic spirometric tests had been carried out on patients presented for elective surgery. RESULTS The majority of patients experienced dyspnea and two patients presented with acute abdomen due to peritonitis. Diagnosis for Morgagni's hernia was made preoperatively in all but one patient. In cases with uncertain diagnosis or peritonitis, a transabdominal approach was preferred. One patient had died of septic multi-organ failure in the early postoperative course. Following elective repair of Morgagni's hernia, improvement in basic spirometric values was seen. CONCLUSIONS We conclude that repair for Morgagni's hernia can be performed safely and effectively by using different surgical approaches. The risk of progression and incarceration makes clinical awareness, early diagnosis, and surgical treatment warranted. Improvement in lung function can be expected postoperatively.
Collapse
Affiliation(s)
- J Pfannschmidt
- Department of Thoracic Surgery, Thoraxklinik Heidelberg, University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|
25
|
Court FG, Wemyss-Holden SA, Fitridge R, Maddern GJ. Unusual case of Morgagni hernia associated with malrotation. ANZ J Surg 2003; 73:772-3. [PMID: 12956800 DOI: 10.1046/j.1445-2197.2003.02745.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Morgagni herniae are rare congenital diaphragmatic hernia, which normally present late in adult life with minimal symptoms. They are always associated with a peritoneal hernial sac, and often contain transverse colon or stomach. We present an unusual case of a Morgagni hernia containing caecum in an 81-year-old woman, post ruptured aortic aneurysm repair.
Collapse
Affiliation(s)
- Fiona G Court
- University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, Australia
| | | | | | | |
Collapse
|
26
|
de Vogelaere K, de Backer A, Delvaux G. Laparoscopic repair of diaphragmatic Morgagni hernia. J Laparoendosc Adv Surg Tech A 2002; 12:457-60. [PMID: 12590730 DOI: 10.1089/109264202762252767] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A novel case of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 5-year-old boy is reported. The patient had a prompt and complete recovery, with no evidence of recurrence noted at 1 year after surgery. Laparoscopic repair is considered to be a suitable and safe procedure for the treatment of Morgagni hernia.
Collapse
Affiliation(s)
- K de Vogelaere
- Department of Paediatric Surgery, Academic Hospital VUB, Brussels, Belgium.
| | | | | |
Collapse
|
27
|
Nguyen T, Eubanks PJ, Nguyen D, Klein SR. The laparoscopic approach for repair of Morgagni hernias. JSLS 1998; 2:85-8. [PMID: 9876719 PMCID: PMC3015255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Morgagni hernias are unusual congenital diaphragmatic hernias that are generally asymptomatic and discovered incidentally. Surgical treatment is indicated once the diagnosis is made. These hernias have traditionally been repaired by the open abdominal or thoracic approaches. We report a case of Morgagni hernia repaired successfully via the laparoscopic approach. METHODS AND RESULTS The patient was noted to have a large anteromedial diaphragmatic hernia by chest radiograph and CT imaging. He underwent laparoscopy, during which the hernia was reduced and the defect repaired with mesh placement. We used intracorporeal suture placement to anchor the mesh. The patient recovered uneventfully after a short hospitalization. CONCLUSIONS The laparoscopic approach for repair of Morgagni hernias offers diagnostic advantages as well as the potential for reduced morbidity when compared to laparotomy. We report intracorporeal knot-tying for fixation of the mesh to be a secure and satisfactory means to achieve the laparoscopic repair.
Collapse
Affiliation(s)
- T Nguyen
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | | | | | | |
Collapse
|
28
|
Akamine S, Kawahara K, Nakamura A, Takahashi T, Yamamoto S, Ayabe H, Tomita M. Successful utilization of a video-assisted thoracic approach to repair Morgagni's hernia: report of a case. Surg Today 1995; 25:654-6. [PMID: 7549282 DOI: 10.1007/bf00311444] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We describe herein the successful utilization of a video-assisted thoracic surgical approach to repair Morgagni's hernia. The patient was a 62-year-old woman in whom a routine chest X-ray had revealed an asymptomatic mass, which was presumed to be a pericardial lipoma or Morgagni's hernia. The video-assisted thoracic surgical approach was combined with a right submammary minithoracotomy to successfully repair the hernia without performing a laparotomy. The patient's postoperative course was uneventful and she was discharged 14 days after surgery. Thus, we believe that video-assisted thoracic surgery may be a useful and effective method for repairing Morgagni's hernia.
Collapse
Affiliation(s)
- S Akamine
- First Department of Surgery, Nagasaki University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
29
|
Wong NA, Dayan CM, Virjee J, Heaton KW. Acute respiratory distress secondary to Morgagni diaphragmatic herniation in an adult. Postgrad Med J 1995; 71:39-41. [PMID: 7708592 PMCID: PMC2397904 DOI: 10.1136/pgmj.71.831.39] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diaphragmatic hernias of the Morgagni type are generally thought to be asymptomatic in adults. This traditional assumption led to a delay in diagnosing a Morgagni hernia as the cause of acute respiratory distress in a chronic schizophrenic man. While Morgagni hernias are usually considered to be long-standing, we present radiological evidence of an acutely expanding hernia. The patient's symptoms were relieved by surgical repair of the hernia. We advise caution before dismissing Morgagni hernias in adults as being long-standing and clinically insignificant.
Collapse
|
30
|
|
31
|
Affiliation(s)
- J S Chu
- Department of Pulmonary and Critical Care Medicine and Radiology, Sepulveda VA Medical Center, UCLA School of Medicine
| | | | | |
Collapse
|
32
|
Yeager BA, Guglielmi GE, Schiebler ML, Gefter WB, Kressel HY. Magnetic resonance imaging of Morgagni hernia. GASTROINTESTINAL RADIOLOGY 1987; 12:296-8. [PMID: 3623002 DOI: 10.1007/bf01885165] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of a Morgagni hernia is demonstrated by magnetic resonance imaging (MRI). The correct diagnosis was facilitated by the ability to image directly the anteromedial diaphragmatic defect in the coronal and sagittal planes. The findings from MRI, computed tomography, and radiographic studies are correlated.
Collapse
|
33
|
Kimmelstiel FM, Holgersen LO, Hilfer C. Retrosternal (Morgagni) hernia with small bowel obstruction secondary to a Richter's incarceration. J Pediatr Surg 1987; 22:998-1000. [PMID: 3430323 DOI: 10.1016/s0022-3468(87)80494-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retrosternal (Morgagni) hernias in children are usually asymptomatic or may be associated with mild respiratory distress or gastrointestinal symptoms. Incarceration of bowel in a retrosternal hernia is unusual with only four reported cases, all in adult patients. This report details an unusual case of complete small bowel obstruction in which the Morgagni hernia sac itself contained the defect through which a portion of small bowel incarcerated as a Richter's hernia.
Collapse
Affiliation(s)
- F M Kimmelstiel
- Department of Surgery, St Luke's-Roosevelt Hospital Center, New York, NY 10025
| | | | | |
Collapse
|
34
|
Abstract
A complicated case of large substernocostal hernia in a 67-year-old man is described. A new surgical approach via upper laparotomy which can be extended by a lower median sternotomy, allowing complete access to the hernia was tried successfully and the patient's recovery was uneventful.
Collapse
|