Morgagni’s Hernia: Analysis of 21 Patients with Our Clinical Experience in Diagnosis and Treatment

Abstract

A Morgagni's hernia is a congenital defect found in the anterior aspect of the diaphragm between the costal and the sternal portions of this muscle. This defect is also referred to as the space of Larrey. It has been reported that 70% of patients with Morgagni's hernia are female, 90% of the hernias are right-sided, and 92% of the hernias have hernia sacs. This type of hernia is a rare clinical entity and accounts for 3% of all surgically treated diaphragmatic hernias. There are no large retrospective or prospective studies on this topic. This type of hernia is a rare type among adults without a well-described prevalence and without well-established definitive management strategies. There are also few clinical reports about this clinical entity and its surgical treatment. We treated 21 patients with Morgagni's hernia in a 12-year period, and we report our experience while discussing the surgical treatment of this disease. We performed a retrospective review of the 21 patients who were operated between 2003 and 2015. These patients had undergone surgical repair of Morgagni's hernia. For each subject, demographic data, symptoms of presentation, physical examination findings, preoperative imaging studies and diagnosis, and surgical procedures were documented. Location of the hernia sac and its contents, postoperative complications, and duration of hospital stay were recorded and evaluated. Twelve patients were females and nine were males. The mean age of patients was 63.85 years. Dyspnea was the most prominent symptom in our patients. Morgagni's hernias were located on the right side in 19 patients and on the left side in 2 patients. Chest X-ray in 10 patients and abdominal computerized tomography in 17 patients were the major diagnostic tools. Four patients were operated as emergency while others underwent elective surgery (17 patients). Twelve patients were operated with laparoscopy and the remaining nine were operated with the conventional open abdominal technique. Hernia sacs were observed in all of the patients and removed except in four of them. The omentum and the transverse colon were the most commonly seen organs in hernia sacs. Hernia defects were repaired with primary sutures in four patients (all open cases) and primary closure supported with mesh in six patients (four laparoscopic, two open cases). In the remaining 11 patients, hernia defects were closed with synthetic meshes (eight laparoscopic, three open cases). Mean postoperative hospital stay was 9.8 days. No recurrence was observed in any patients. Only one of our patients died during follow-up. In Morgagni's hernias, surgical intervention is necessary as the hernia may cause complications such as strangulation of the colon or intestines. A laparoscopic approach has increased its popularity in recent years because of the well-known advantages of laparoscopy.

Larrey diaphragmatic hernia in an adult

“…), with gangrene formed and with perforation [6,10]. The most common content of the anterolateral hernias is the omentum and the transversal colon, which was the case with our patient [11].…”

Obstructed right Morgagni hernia with multiple congenital anomalies: a rare presentation

“…Anterior defects in the diaphragm were first discovered in 1796 by Giovanni Batista Morgagni and described as Morgagni hernias. 2,3 These are the rarest of all congenital diaphragmatic hernias accounting for only 3% of cases. [4][5][6] The pathophysiology of diaphragmatic hernias is not well known.…”

“…7 It has been reported that almost 70 % cases of Morgagni hernias are females. 3 Although cases of Morgagni hernia can present in early childhood with respiratory symptomatology, most of the cases remain asymptomatic and are detected later in life. 7 In most of the cases symptoms are usually respiratory followed by gastrointestinal.…”

“…1,2 About 5-10% individuals remain asymptomatic during childhood and symptoms appear later in life. 3 Its aetiology is poorly understood and is thought to be both due to genetic and environmental factors. 1 Affected genes include transcription factors such as GATA4, ZFPM2, NRF2 and WT1.…”

Diaphragmatic fenestrations seen after peritoneal dialysis catheter placement: A rare cause of hydrothorax

“…Source: Adapted from Arikan et al 3 (https://www.sages.org/video/v066-laparoscopic-repair-incarcerated-diaphragmatic-hernia/)…”