Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report

Abstract

BackgroundMorgagni’s hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly.Case presentationA 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised.ConclusionsGastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0399-y) contains supplementary material, which is available to authorized users.

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

“…8 In thoracoabdominal CT, inferior chest sections should be obtained, as well as of the abdomen in order to delimit the extension of the hernia, as well as the presence of abdominal organs at chest level, as well as evidence of complications such as base atelectasis and pleural effusion ipsilateral to herniation. 6,7 CT was the exam of choice for confirm the hypothesis raised by the chest X-ray of the case, which confirmed the diaphragmatic hernia, which was classified as Morgagni, in the left hemithorax with mesenteric and intestinal contents, corroborating with the literature on the contents of the hernia sac on the left. Surgery is the only curative treatment of choice in symptomatic or nonsymptomatic patients, being transthoracic, transabdominal, laparoscopic or thoracoscopic.…”

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

“…Gastrostomy and PEG have added advantage for patients who have difficulties in oral intake. Gastrostomy and PEG are both used to provide fixation of the anterior stomach to the abdominal wall [ 114 – 116 ]. The use of PEG or combined PEG/laparoscopy in the treatment of DH is successful in relieving symptoms, preventing recurrence, stopping progression of complications (such as gastric ischemia), has very low morbidity, and is well tolerated, especially in high-risk elderly patients who are otherwise unsuitable candidates for a definitive surgical repair [ 117 , 118 ].…”