Bilateral Morgagni Hernia: Primary Repair without a Mesh

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.

Diaphragmatic hernia - Case series and Literature review

“…(7) Computed tomography scan is diagnostic. Magnetic Resonance Imaging (MRI) can distinguish Morgagni's hernia from other mediastinal masses (8).To avoid the complications like strangulation, some recommend repair even in asymptomatic patients whereas some advocate conservative approach because Morgagni's hernia remains asymptomatic for a long time (9,10).…”

“…In cases of certain diagnosis, abdominal approach (open or laparoscopic) is preferred over thoracic approach for surgery because of easier reduction of the hernial contents into the peritoneal cavity (11).…”

Strangulated Morgagni’s Hernia: A Rare Diagnosis and Management

“…Because of extensive pericardial attachment on the left which does not allow herniation, the hernia is more common on the right side and is situated anteriorly [7]. Almost 90% of Morgagni's hernias are reported to be on the right side, with 2% located on the left and 8% bilateral [8]. The sac lies between the pericardium and the right pleura.…”

“…Computed tomography scan can be useful in diagnosing the contents of the hernia sac and is noninvasive and accurate. Magnetic resonance imaging can distinguish Morgagni's hernia from other mediastinal masses and is noninvasive too [8]. Pleuropericardial cyst, lipoma, intrathoracic tumours, and eventration of diaphragm should be differentiated from Morgagni's hernia while making a diagnosis [9].…”

“…A subxiphoid preperitoneal approach has the benefit of a small incision [9]. In cases of certain diagnosis, abdominal approach (open or laparoscopic) is preferred over thoracic approach for surgery because of easier reduction of the hernia and because abdominal viscera within the hernia can be easily pulled down to their normal location [8]. In cases of unclear diagnosis, the recent trend is towards laparoscopy which has low morbidity [6].…”