Hernia de Morgagni en la edad adulta

Introducción: La hernia de Morgagni es una anomalía congénita rara, responsable del 3% de las hernias diafragmáticas, que provoca opacidades radiológicas paracardíaca y retroesternal que suelen confundirse con otras afecciones. Objetivo: Notificar el caso de un paciente adulto diagnosticado con hernia de Morgagni en el Hospital General Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Caso clínico: Se presenta el caso de un varón de 28 años de edad con antecedentes de contusión torácica severa, que presentó dolor abdominal, dispepsias, dolor recurrente en región baja posterior del hemitórax derecho, falta de aire ligera y tos seca. Con la aplicación de un correcto método clínico se excluyeron otros posibles diagnósticos planteados previamente y se concluyó con estudios imagenológicos como una hernia de Morgagni. Se realizó tratamiento quirúrgico mediante laparotomía convencional. La evolución fue favorable, sin complicaciones posoperatorias y con egreso hospitalario precoz. Conclusiones: Se notificó el caso de un paciente diagnosticado con hernia de Morgagni que constituyó un tipo raro de hernia en adultos, cuyo diagnóstico se debe tener en cuenta en pacientes con manifestaciones clínicas digestivas o respiratorias, que presentan radiopacidad paracardíaca en la radiografía de tórax. Es necesario realizar tratamiento quirúrgico oportuno para prevenir posibles complicaciones.

Introduction: Morgagni's hernia is a rare congenital anomaly, responsible for 3% of diaphragmatic hernias, which causes paracardiac and retrosternal radiological opacities that are often confused with other conditions. Objective: To report the case of an adult patient diagnosed with Morgagni's hernia at "Dr. Antonio Luaces Iraola" General Teaching Hospital from Ciego de Avila. Clinical casereport: We report the case of a 28-year-old man with history of severe chest contusion, who showed abdominal pain, dyspepsia, recurrent pain in the lower posterior region of the right hemithorax, slight shortness of breath, and dry cough. With the use of the correct clinical method, other possible diagnoses were excluded from what was previously raised. Imaging studies concluded to be a Morgagni hernia. Surgical treatment was performed by conventional laparotomy. The evolution was favorable, without postoperative complications and with early hospital discharge. Conclusions: The case of a patient diagnosed with Morgagni's hernia was reported. It constituted a rare type of hernia in adults. Its diagnosis should be taken into account in patients with digestive or respiratory clinical manifestations, showing paracardiac radiopacity on chest X-ray. Timely surgical treatment is necessary to prevent possible complications.

Laparoscopic mesh repair of Morgagni hernia: Two-case report / 中国胸心血管外科临床杂志

@#Morgagni hernia is a rare form (accounting for 2%) of congenital diaphragmatic hernia. The traditional treatment for Morgagni hernia includes thoracotomy and laparotomy. However, surgical trauma limits its adoption. We reported the results of 2 patients with congenital Morgagni hernias in adults and described the operation methods of the patients. The 2 patients recovered uneventfully. No evidence of recurrence was found after 5 years follow-up. Laparoscopic repair for Morgagni hernia with mesh is applicable for obese, aged and bilateral Morgagni hernias patients.

Hernia de Morgagni en el adulto / An Adult with Morgagni Hernia

La hernia diafragmática de Morgagni suele presentarse con poca frecuencia en adultos dado su origen congénito. Por este motivo, suele confundirse desde el punto de vista imagenológico con un lipoma mediastinal, como el caso que nos ocupa. Se presenta un caso de hernia diafragmática de Morgagni en adulto, la cual fue intervenida quirúrgicamente por videotoracoscopia con una evolución posoperatoria satisfactoria(AU)

The Morgagni diaphragmatic hernia usually occurs with a low frequent in adults due to its congenital origin. Therefore, it is often mistaken, imaginologically speaking, for a mediastinal lipoma, as in this case of interest. A case is presented of an adult with a Morgagni diaphragmatic hernia, which was surgically intervened by video-assisted thoracoscopy with a satisfactory postoperative evolution(AU)

rare case of Bochdalek diaphragmatic hernia with concomitant partial situs inversus.

Congenital diaphragmatic hernias clinically presenting in adulthood are exceedingly rare lesions, mainly left-sided defect (Bochdalek). Bochdalek hernias most commonly manifest during the patient’s first few weeks of life. Diagnosis beyond the first 8 weeks of life is estimated to represent 5-25% of all Bochdalek hernias. Here we have a 32 year old female patient who presented with 10x10 cm diaphragmatic hernia with dextrocardia who was asymptomatic for years.

Unusual Diaphragmatic Hernias Mimicking Cardiac Masses

Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features.

Hernia diafragmática no traumática complicada en un anciano / Non traumatic complicated diaphragmatic hernia in an old man

La hernia de Morgagni es una variedad poco frecuente de hernia diafragmática no traumática. En un paciente anciano del sexo masculino se encontró un gran saco herniario que contenía estómago, epiplón mayor y colon transverso, encarcelados a través de un defecto diafragmático retroesternal, lo cual es muy raro en la vejez. El paciente tenía antecedentes de litiasis vesicular, úlcera duodenal y diastasis de los músculos rectos abdominales, e ingresó con dolor torácico, epigastralgia, aerogastria, distensión en la porción superior del abdomen y vómitos. El diagnóstico se obtuvo mediante radiografías posteroanterior y lateral del tórax y del abdomen. Se realizó una laparotomía de urgencia y se encontró una hernia de Morgagni encarcelada sin afectación vascular. Se redujo el contenido, se resecó el saco herniario, se reparó el defecto herniario y se efectuó la colecistectomía. La recuperación posoperatoria fue inmediata y completa. El seguimiento posoperatorio de 6 meses no mostró recidiva herniaria(AU)

Morgagni hernia is an uncommon variety of non-traumatic diaphragmatic hernia, usually located in the right-side anterior diaphragm. A big herniary sac, which contained the greater omentum, the stomach, and the transverse colon incarcerated due to a retrosternal diaphragmatic defect, was found in an old male patient. This is very unusual finding in the elderly. This patient had a history of cholelithiasis, duodenal ulcer and diastasis recti. He was admitted at the hospital with chest pain, epigastralgia, aerogastria, upper abdominal distension, and vomits. He underwent emergency radiological studies. The diagnosis was based on chest posterior-anterior and lateral X-rays of the chest and the abdomen. Emergency laparotomy was performed to find Morgagni hernia without any vascular effect. The content was removed, the hernia sac was excised, the Morgagni foramen was repaired and cholecistectomy was performed. The recovery of the patient was complete and immediate postoperatively. The six-month follow-up showed no hernia recurrence(AU)

Oclusión intestinal por hernia diafragmática derecha encarcelada / Intestinal occlusion for incarcerate left diaphragmatic hernia

La hernia de Morgagni es un defecto congénito de la cara anteromedial del diafragma, que se presenta de forma infrecuente en el adulto. En la mayor parte de los casos su diagnóstico es un hallazgo incidental, y por lo general, los pacientes se encuentran asintomáticos. Se diagnostican radiológicamente y posteriormente se indica la cirugía por el riesgo de estrangulación. Se presentó un caso clínico de una paciente de 78 años, con previo diagnóstico de hernia diafragmática derecha mediante técnicas imagenológicas, que comenzó con manifestaciones de cuadro oclusivo. Fue operada de urgencia por vía transabdominal, se hizo la reducción del saco herniario donde se encontraba epiplón, colon transverso y parte del estómago, y se reparó el defecto diafragmático. El propósito de este trabajo fue reportar un caso reciente de oclusión intestinal causada por hernia de Morgagni encarcelada, su diagnóstico y abordaje quirúrgico.

The Morgagni hernia is a congenital defect of the diaphragm anteromedial side, infrequently present in adults. In most of the cases its diagnosis is an incidental finding, and in general the patients are asymptomatic. They are diagnosed radiologically, and once diagnosed the surgery is indicated to avoid the risk of strangulation. We presented the clinical case of a 78-years-old female patient with a previous diagnosis of left diaphragmatic hernia obtained using imaging techniques, who began with manifestations of an occlusive picture. She was immediately operated by transabdominal way, reducing the hernia sac containing mesentery, transversal colon and part of the stomach, and the diaphragmatic defect was repaired. The purpose of this work was reporting a recent case of intestinal occlusion caused by incarcerated Morgagni hernia, its diagnosis and surgical management.

Morgagni Hernia Presenting as Obstructive Jaundice.

Morgagni’s hernia is rare in pediatrics, representing 1%-6% of all congenital diaphragmatic hernias (CDH). We report a young boy presented with obstructive jaundice caused by compression of common bile duct (CBD) due to stretching and rotation of second part of duodenum in right-sided Morgagni hernia. Such presentation is rarely reported in literature.

The Laparoscopic Repair of a Morgagni Hernia in a Child

A 12-year-old female presented with the abnormal findings on the chest PA. The chest CT revealed a retrosternal defect of the diaphragm and a fatty opacity in the pleural cavity, resulting in a diagnosis of Morgagni hernia. It was decided to undergo a laparoscopic surgery. The retrosternal defect of the diaphragm measuring 3.5 cm in diameter was found, through which a portion of the greater omentum and the fatty tissue connected with the falciform ligament were herniated into the pleural cavity. The greater omentum was pushed back into the peritoneal cavity and the fatty tissue connected with falciform ligament was excised. The mediastinal pleura was plicated and the defect of the diaphragm was repaired primarily. Immediately after the operation, the patient developed a right pneumothorax for which a chest tube was inserted. She was discharged at the post-operative third day without any further complications.

Congenital Intercostal Lung Herniation Combined with an Unusual Morgagni's Hernia

A 70-year-old male visited urgent care due to coughing for 1 month and left chest pain. He had no history of trauma. The initial chest computed tomography (CT) showed the 7th left intercostal lung herniation. A follow-up CT showed an intercostal lung herniation combined with a bowl herniation, which had developed due to a Morgagni's hernia. An emergency operation was performed due to the incarceration of the bowl and lung. The primary repair of the diaphragm was performed and the direct approximation of the 7th intercostal space was determined. We concluded that the defect of the diaphragm and the intercostal muscle was a congenital lesion, and the recurrent coughing was the aggravating factor of herniation.

Morgagni hernia with down syndrome: A rare association.

We report a case of a 22-year-old male with Down syndrome and Morgagni hernia, who presented to us with complaints of cough, regurgitation and vomiting. He was successfully treated surgically and the defect was repaired with prolene mesh.

A Case of Left-sided Morgagni Hernia Complicating Incarcerated Small Bowel Hernia / 대한소화기학회지

Morgagni hernia is an uncommon presentation representing about 3% in incidene and usually located in the right-sided anterior diaphragm. We experienced a case of Morgagni hernia in a seventy four-year-old male who was admitted complaining of intermittent abdominal pain. The diagnosis was made initially by chest and abdominal radiography, and an incarcerated Morgagni hernia was finally diagnosed with abdominal CT scans. Emergent laparotomy was performed. Morgagni foramen was located on the left-sided anterior diaphragm and Morgagni hernia which contained greater omentum and strangulated small intestine was gently reducted. Morgagni foramen measuring 4x5 cm was repaired with a Gortex mesh. We reported the experience of left-sided Morgagni hernia complicating incarcerated small bowel hernia in an old male patient.

Morgagni Hernia in a 3-year Old Boy: a Case Report

A 3-year-old boy with purulent otitis media received a chest radiograph as the part of a routine work up. The patient was normal appearing, in no acute distress. The patient's lung and heart sounds were clear and normal. The patient's abdomen was soft, non-distended, and non-tender. An anterior cardiophrenic mass was incidentally identified on the lateral chest radiograph. A computed tomography scan demonstrated a diaphragmatic hernia with bowel loops in the retrosternal space. An exploratory operation revealed a diaphragmatic defect (4 cm in diameter) on the left side of the falciform ligament, through which transverse colon was protruded. There was no hernia sac, and the defect was closed with interrupted No. 2 silk sutures. The child was discharged on the 8th postoperative day without any complications. During 6 months of follow-up period, recurrence was not noticed.

Morgagni Hernia with Cecal Perforation

Morgagni hernia is known as the smallest form of diaphragmatic hernia and it is usually asymptomatic. However, almost all the cases reported in the Korean literature have been symptomatic and they were surgically repaired. The authors report here on a case of Morgagni hernia that was found accidentally during the preoperative workup of a patient who suffered from panperitonitis with cecal perforation. The patient was transferred from the local hospital with complaints of pain in the entire abdomen. On the preoperative CT, a large paracardial mass and a collection of intra-peritoneal free air were identified. After reduction of the hernia contents, the hernia was repaired with using mesh. The patient showed a rapid recovery without any complication.

Morgagni Hernia

The cause of a congenital diaphragmatic hernia is unknown. However, it is believed to result from a failure of pleuroperitoneal canal closure in a developing embryo. Congenital herniation of the anteromedial, retrosternal diaphragm is known as Morgagni hernia. We experienced a case of Morgagni hernia in an eighty three-year-old female who was admitted complaining of right upper abdominal pain. The Morgagni hernia was found incidentally by abdominal CT, Chest PA and right lateral view during the work up. A reduction of the transverse colon and greater omentum, and a cholecystectomy were performed. The size of the opening was 5x6 cm. The patient was discharged without complications.

A Case of Morgagni Hernia

Morgagni hernia is a congenital diaphragmatic hernia that occurs secondary to potential anterior medial defects in the diaphragm. These hernias are uncommon, accounting for 3% of all diaphragmatic hernias, and the incidence is higher in patients over the age of 50 years than in younger patients. They are most commonly found incidentally on chest radiographs since most patients are asymptomatic, although symptoms of bowel obstruction may be present. Surgical repair is required in all cases and may be performed using a transabdominal, transthoracic, or laparoscopic approach. We report a case of a congenital diaphragmatic hernia through the Morgagni foramen in 70-year-old female, as well as a brief review of the literatures.

Two Cases of Sliding Hiatal and Morgagni Hernia Mimicking Pericardial Lipomas

The differential diagnosis between pericardial and non-cardiac masses may be sometimes difficult in the evaluation of chest mass adjacent to the heart. One misdiagnosed case of non-cardiac mass as a pericardial mass turned out to be a hernia. When the contents of hernia originate from the gastrointestinal tract, the diagnosis is made easily by air-fluid shadow on plain chest roentgenogram. Morgagni hernia is usually detected on plain chest roentgenograms as a smooth, supradiaphragmatic shadow at the right pericardiophrenic angle. In the case of Morgagni hernia, in which the contents are only the omentum, it is necessary to differentiate the hernia from mediastinal fatty tumors. We report two cases of hiatal and Morgagni hernia containing omentum which were misdiagnosed as pericardial masses.

Morgagni hernia in infants and children

The cumulative data regarding five cases of Morgagni hernias in infants and children over the last six years have been reviewed. All five patients were clinically normal upon presentation; however, the most common symptoms and signs were respiratory. Chest x-ray was the most common diagnostic test. The diagnoses were also later confirmed with preoperative barium meal studies. All of the patients had additional congenital anomalies, of which malrotation of the gut was the most commonly encountered. Upon operation, all of the cases contained a hollow viscus, and had a sac. The defects were repaired through abdominal approaches. There was no mortality and postoperative complication in these series.

Air Shadow Containing Mass Lesion in the Chest / 결핵

A 70-year-old female Patient was admitted due to the impression of lung abscess via local clinic. Chest P-A showed air shadow containing huge mass lesion in the right lower lung field, pericardio phrenic angle. But the patient complained of only mild upper respiratioy tract infection symptoms and the laboratory tests were within normal limits. Barium enema and chest C-T taken right after barium enema were performad in suggesting of the diaphragmatic hernia. Barium tilled transverse colon and associated omentum were in the right anterior hemithorax surrounded by the hernial sac. The mass lesion shown in the chest P-A was compatible with the diaphragmatic hemia, Morgagni type. Operative reduction of the herniated bowel and simple closure of the diaphragm was performed.

Morgagni hernia: Report of a case.

A case of Morgagni hernia was encountered in a female patient aged 72 years, who was suffering from abdominal discomfort and shortness of breath. A preliminary diagnosis of mediastinal lipoma was suggested by computed tomography findings. However, during right-sided thoracotomy, a large Moregagni hernia containing a cluster of omentum completely enveloped in a peritoneal sac, was removed.