Case of giant paraesophageal hiatal hernia associated with Morgagni hernia

Ozawa, Hiroki; Shinozaki, Hiroharu; Kimata, Masaru; Ozawa, Soji

doi:10.1111/ases.12398

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…A unifying feature of the few previously reported cases of concurrent paraesophageal and Morgagni hernias is the presence of chest pain, gastrointestinal complaints, or both [6]. This case differs in that our patient denied either angina or gastrointestinal discomfort and instead presented with elusive atypical paroxysms of cough-associated syncope.…”

Section: Commentmentioning

confidence: 53%

Intestinal Tamponade

Coolidge

Czerniach

Wiener

2019

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 53%

Intestinal Tamponade

Coolidge

Czerniach

Wiener

2019

The Annals of Thoracic Surgery

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“…The technique of intracorporeal mesh closure has been proven to reduce recurrence of the hernia and adhesions, gaining space in these repairs. 9,13 Reports of MH correction by such a pathway in advanced age patients reiterate their safety, combined with a prior analysis -minute operation 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The patient of the case did not present any risk factor for the increase of this pressure, which reiterates its congenital origin. 8,14,15 Due to cardiorespiratory discomfort and gastrointestinal manifestations, diagnosis and treatment in childhood become more prevalent, making the diagnosis in adult life uncommon, with reports of a higher incidence in females in more than 50% of cases and the mean of age of the diagnosis of 53 years. The clinical picture varies according to the size of the defect and herniated organ, and, unlike the child, the symptoms are chronic, and may present with nausea, vomiting, anorexia, abdominal pain, chest pain, dyspnea, dyspepsia or even asymptomaticthe absence of symptoms due to the fact that the organs are commonly lined by the parietal peritoneum of the hernia sac.…”

Section: Discussionmentioning

confidence: 99%

Morgagni Hernia as a Differential Diagnosis in an Adult: A Case Report

Nóbrega

Araújo

Araújo³

et al. 2019

AIMJ

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Morgagni Hernia (MH) is a defect between the transverse septum and the sternum, failing the fusion of the sternal and costal parts of the muscle, representing 3 to 4% of the hernia’s diaphragmatic lesions of congenital origin. It is present in 90% of the cases on the right side, 8% on the left side and 2% on the bilateral side. The aim of this article is to report a case on late presentation of MH and to emphasize the importance of this pathology to be analyzed with differential diagnosis in patients with respiratory symptoms. The subject is a patient, male, 62 years old, truck driver, married, with history of dyspnea on medium exertion and mild chest discomfort from 2 years. After 1 year of these symptoms, he evolved with major dyspnea on minor exertion, intense chest pain, without improvement with analgesics or with body positions, making it difficult to perform his usual activities as work and leisure. Multislice Computed Tomography of the Thorax, which showed: diaphragmatic hernia in the left hemithorax, with a ring/diaphragmatic fault located in the anterior and medial pericardial third, and an intrathoracic hernia, notably in the base and middle third in the anterior, lateral and posterior regions, with contents mesenteric and intestinal. The patient underwent thoracotomy in the sixth left intercostal space. A large amount of omentum, transverse colon, stomach, pulmonary atelectasis and small pleural effusion were found. The omentum resection was performed, located hernial ring in the antero-medial portion of the diaphragm, reduction of the hernia, placement of the Malex mesh and apposition of two anterior and posterior thoracic drains. Reports of patients initially diagnosed with pneumonia or treated as chronic dyspeptic, who progressed to intestinal necrosis, respiratory failure or other complications due to late diagnosis, emphasize the relevance of the knowledge of MH as a differential diagnosis of respiratory and gastrointestinal symptoms.

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“…A series of studies have reported acute complications of giant hiatal hernia such as acute gastric volvulus, intrathoracic gastric perforation, and incarcerated obstruction of the herniated viscera (8,13,22,23). Romano et al demonstrated the length of stay and mortality of elderly patients was obviously increased in a non-elective giant hiatal hernia repair group compared with an elective repair group (24).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic repair of giant hiatal hernia for elderly patients

Guan¹,

Nie²,

Yuan³

et al. 2021

Ann Transl Med

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Background: Giant hiatal hernias are more common in older patients and can significantly reduce their quality of life. However, open surgery for patients of advanced age is thought to be associated with high morbidity and mortality. The aim of this retrospective study was to evaluate the safety of laparoscopic giant hiatal hernia repair for elderly patients as compared to younger patients.Methods: From January 2015 to January 2020, 152 consecutive patients underwent laparoscopic mesh repair of giant hiatal hernia. Two cases of missing follow up were excluded. Patients were divided into an elderly group (N=62, age ≥75) and a younger group (N=88, age <75). Interrupted non-absorbable suture was applied for crus closure and as an additional reinforcement, the mesh was fixed with absorbable tacks or medical glue. Procedure-related complications, score-based variation tendency of symptoms, gastrointestinal quality of life index (GIQLI), mortality, recurrence rate, hemoglobin, and the use of PPI were investigated.Results: All patients underwent the procedure uneventfully. Dor fundoplication was used in 39 patients (62.9%) in the elderly group and 44 (50.0%) in the younger group and no case was converted to open.While the elderly group had a significantly higher percentage of ASA Class level 3 and cardiovascular and cerebrovascular diseases as compared to the younger group, the two groups had similar operative times, intraoperative blood loss, and percentage of intrathoracic stomach. Elderly group patients tended to have higher perioperative complications including pneumonia (3.2%) and atelectasis (3.2%) without statistical significance, as well as transfer to the intensive care unit compared, to younger patients (9.7% vs. 3.2%; P=0.144). The mean post-operative hospital stay was also significantly shorter in the younger group (2.8 days) compared with the elderly group (3.5 days; P=0.001). There was no mortality, recurrence, meshrelated complications such as visceral erosion, adhesion, or severe dysphagia during follow up in the two groups, and both groups demonstrated significant improvement in GIQLI scores and hemoglobin. The percentage of patients who needed PPI was also reduced in both groups.Conclusions: Laparoscopic mesh repair of giant hiatal hernia for elderly patients is safe and effective when performed at experienced centers.

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Case of giant paraesophageal hiatal hernia associated with Morgagni hernia

Cited by 7 publications

References 9 publications

Intestinal Tamponade

Intestinal Tamponade

Morgagni Hernia as a Differential Diagnosis in an Adult: A Case Report

Laparoscopic repair of giant hiatal hernia for elderly patients

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