Hernia of Morgagni and Mediastinal Lipoma: A Case Report

Abstract

A hernia of Morgagni (also called hernia of Morgagni-Larrey) is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The Morgagni hernia can create uncertainty in its diagnosis and difficulty for subsequent treatment. If after clinical examination and x-ray we suspect the hernia, computed tomography imaging should be the desired imaging method to confirm the diagnosis. Surgery is the only definitive treatment. When a patient presents signs and symptoms of incarceration or strangulation, emergency surgery is required. We report the first life-threatening case of an association between a hernia of Morgagni and a mediastinal lipoma. We present an adult patient with mediastinal lipoma and a right incarcerated hernia of Morgagni with engagement of the stomach, the duodenum and the transverse colon, successfully treated without complications. To our knowledge, this is the first report of an association between those two rare entities in an acute setting. We discuss the differential diagnosis and physiopathology of the condition, referring to published reports.

Morgagni Hernia Repair: A Review

“…Of the 171 cases identified from 76 articles in the past decade (Tables 1-3), 13-81 the majority of reported MH repairs were attempted through minimally invasive techniques (31), including laparoscopy (30) and thoracoscopy (1), followed by open abdominal approaches (31) exclusively attempted via laparotomy (31), and finally...…”

“…As in all cases of suspected ischemia, a thorough workup should be completed in patients who raise clinical suspicion of mesenteric or bowel strangulation because MH can be easily overlooked. 24…”