Morgagni Hernia: Unique Presentations in Elderly Patients

Lev-Chelouche, Dina; Ravid, Avi; Michowitz, M; Klausner, Joseph M.; Kluger, Yoram

doi:10.1097/00004836-199901000-00022

Cited by 42 publications

(36 citation statements)

References 5 publications

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“…Predisposing conditions, present in 41% of the cases, included pregnancy, trauma, obesity, chronic constipation, chronic cough [2][3][4][5], and any condition the author thought contributed to the patient's clinical presentation.…”

Section: Resultsmentioning

confidence: 99%

“…Pregnancy, trauma, obesity, chronic constipation, and chronic cough are common predisposing conditions cited in the literature [2][3][4][5]. The common thread in these conditions is increased intraabdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Two cases of herniation after peritoneal dialysis have been reported [37,38]. Furthermore, herniation has been attributed to pancreatitis that caused increased intraabdominal pressure [4].…”

Section: Discussionmentioning

confidence: 99%

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Presentation and management of Morgagni hernias in adults: a review of 298 cases

2008

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Section: Discussionmentioning

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Presentation and management of Morgagni hernias in adults: a review of 298 cases

2008

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“…This weakness in the diaphragm later would be stretched by rapid rise in intraperitoneal pressure, giving rise to a hernia. Lev-Chelouche et al mentioned that it is for this reason that hernia of Morgagni is usually not discovered in children (1 ) .…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Obstructed Morgagni’s Hernia Presenting in a Child.

Joshi¹,

Gadhire²,

Mishra³

et al. 2013

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KEYWORDS: Obstructed Morgagni's HerniaCASE HISTORY: A 13 year old, obese girl weighing 76 Kg, with a height of 170 cm, who was asymptomatic till a week back, presented to the emergency department with a history of worsening abdominal pain, distension of abdomen, vomiting, and constipation on and off since 6 days. She had no significant past paediatric /medical /surgical or family history. She was admitted at a private hospital for these complaints for past two days and was referred to us.At presentation, she was dehydrated with BP of 100/68 mm hg, pulse rate of 94/min and Respiratory Rate of 24/min. Her abdomen was distended with diffuse tenderness, but no guarding or rigidity. Abdominal X-ray showed multiple air fluid levels, with dilated bowel loop in right upper quadrant, X-ray chest showed space occupying density supradiaphragmatic near the right border of heart. Lab investigations revealed anaemia, leucocytosis, and hypokalemia with hypochloraemia. CT scan revealed-3.6x2.9 cm (ML x AP) sized defect in the anterior diaphragmatic aspect in midline below the xiphisternum through which a approximately 9 cm long loop of transverse colon and mesocolon was herniating in to the anterior mediastinum, causing widening of retrosternal space and compression effect and displacement of heart towards the left with atelectasis of Right Middle Lobe of the lung.The patient was resuscitated with intravenous fluids, started on intravenous antibiotics, was transfused two packed RBC preoperatively. Then patient was taken up for emergency exploratory laparotomy. A finding of an obstructed transverse colon loop going in through a 4x3 cm defect in the diaphragm was confirmed. With gentle manipulations and adhesiolysis the bowel loop was negotiated into the abdomen from the defect. Sac was left in situ and defect was closed with intermittent nylon sutures. The sutured defect was then covered with polypropylene mesh and anchored all around with polypropylene sutures. On post-operative day two, the patient was started on oral sips and gradually, followed by, liquids and soft diet. With an uneventful post-op recovery, she was discharged on day six. DISCUSSION:Hernia of Morgagni is the rarest of the four types of congenital diaphragmatic hernia (2%-3% of all cases). Hernia of Morgagni was first described by Giovanni Battista Morgagni, an Italian anatomist and pathologist in 1769, while performing a postmortem examination on a patient who died of a head injury. Hernia of Morgagni is located just posterolateral to the sternum. It has also been called retrosternal, parasternal, substernal, and sub costosternal. It is caused by a congenital defect in the fusion of septum transverses of the diaphragm and the costal arches. This weakness in the diaphragm later would be stretched by rapid rise in intraperitoneal pressure, giving

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“…In the adult population, Morgagni hernia presents with respiratory symptoms (recurrent chest infections, respiratory distress), gastroenterology symptoms (vomiting, constipation, gastric outlet obstruction and strangulation) and syncope while defaecating 2 3. Surgical repair is usually done in acute phases and should be considered in asymptomatic cases to avoid future risk of surgical emergencies and death 1.…”

Section: Descriptionmentioning

confidence: 99%