Adult Onset Morgagni Hernia: Medical vs. Surgical Management

Abstract

Morgagni hernia is a type of diaphragmatic hernia where bowel content herniates through an irregular opening into the thoracic cavity. Herein, we present the case of an 84-year-old female patient with multiple hospital admissions for abdominal symptoms. Radiological studies confirmed Morgagni hernia. She underwent a laparoscopic intervention with mesh placement. She was discharged in stable condition and was doing well on follow-up.

VATS Approach to Symptomatic Morgagni Hernia in Adults

“…The propaedeutic should be followed by chest and abdomen CT scan, a highly sensitive test that, for revealing anatomical details, associated complications and defining the herniated structure, is considered the gold standard diagnosis. Other methods that help the characterization of this pathology are ultrasound, endoscopy of the upper gastrointestinal tract, contrasted enema and Magnetic resonance imaging (MRI) [5,[8][9][10].…”

“…A literary review study published in 2008 highlights that among 298 analyzed cases of MH in adults, only 2 were addressed by thoracoscopy [9]. Although they can culminate in a longer surgical time, they should be preferred when available [5,6,14,15]. Literature review studies show that the approach of MH by thoracoscopy allows easy dissection of the hernial sac from mediastinal and pleural structures in addition to providing sufficient exposure for its repair [3,9,12].…”

“…It is extremely rare, comprising about 2 to 4% of diaphragmatic hernias of congenital origin, with the majority occurring in the right hemi thorax. When manifested in neonates, severe and fatal respiratory symptoms occur [2][3][4][5][6].…”

“…Most patients are asymptomatic or have non-specific gastrointestinal symptoms (epigastric pain, nausea and vomiting) and cardiopulmonary (cough, palpitations and dyspnea), making it a diagnostic challenge in adulthood. When complications occur due to imprisonment or strangulation of structures in the diaphragmatic defect, obstructive symptoms may appear [2,[4][5][6][7][8]11].…”

Congenital Morgagni hernia presenting as complete small bowel obstruction in the adult - A case report

“…Morgagni hernia is a type of diaphragmatic hernia where the bowel content herniates through an irregular opening first described in 1769 by Italian anatomist and pathologist Giovanni Battista Morgagni) [ 9 ]. This type of hernias constitutes only 2%–4% of congenital diaphragmatic hernias and symptomatic adult cases are extremely rare.…”