Intestinal Obstruction Caused by a Strangulated Morgagni Hernia in an Adult Patient

Abstract

A Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect. The reported incidence of congenital diaphragmatic hernias is estimated to be 1 in between 2000 to 5000 births. Morgagni hernias comprise 2% of diaphragmatic hernias. Most Morgagni hernias are found and repaired in children, but 5% are found in adults. They are usually asymptomatic and often found incidentally on chest radiography. Symptoms of these hernias are attributable to the herniated viscera. Morgagni hernias containing bowel may require repair on presentation because of the risk of incarceration. We present a case of an incarcerated and strangulated Morgagni hernia in a 71-year-old woman admitted to our clinic for abdominal pain and symptoms of intestinal obstruction. The diagnosis was made preoperatively by chest radiography, sonography, and computed tomography. Emergent laparotomy was performed, with the herniated transverse colon and omentum reduced into the abdomen. The diaphragmatic defect was repaired, followed by resection of the strangulated omentum. In conclusion, a Morgagni hernia may cause intestinal obstruction. Routine radiographic studies are usually sufficient to arrive at the diagnosis, but a CT scan and sonography may be necessary. Laparotomy is appropriate for the management of symptomatic adult patients with Morgagni hernias, particularly those with findings of intestinal strangulation, with laparoscopic treatment an alternative approach in selected cases.

Morgagni hernia: Report of two cases and brief review of anatomy and literature

“…[2,3] The overwhelming majority of Morgagni hernias are diagnosed in children, though approximately five percent are diagnosed in adults. [1] The most common adult presentation is in middle-aged, overweight women. [4] Trauma, severe exertion, and obesity may cause enlargement of previously clinically insignificant hernias in adults, leading to symptoms and late presentation.…”

“…[4] Trauma, severe exertion, and obesity may cause enlargement of previously clinically insignificant hernias in adults, leading to symptoms and late presentation. [1] In children, Morgagni hernias are frequently associated with other congenital anomalies. They may present with severe respiratory distress, recurrent chest infections, or intermittent gastrointestinal symptoms.…”

“…[4] Diaphragmatic hernia through this space was first described by the Italian anatomist Giovanni Morgagni in 1769. [1] The Morgagni hernia appears as an oval shaped defect on a transverse axis. Its front edges are combined to the osteocartilaginous thoracic wall, and its back edges are joined to the muscular edge of the diaphragm.…”

“…Congenital diaphragmatic hernias occur in an estimated 1 in 2,000-5,000 births, [1] and approximately three percent of these are Morgagni hernias. [2] The diaphragm is derived from the septum transversum ventrally, the pleuroperitoneal membrane and body wall laterally, and mesoesophagus mediodorsally.…”

“…[4] Ninety percent of Morgagni hernias are right sided, two percent left sided, and eight percent bilateral. [1] Morgagni hernias are rarer on the left side because the pericardial sac forms a barrier on the sternocostal trigon. [6] Fifty to seventy percent of patients diagnosed with Morgagni hernias are asymptomatic, and their hernias are found during workup of other problems.…”