A CASE OF MORGAGNI'S DIAPHRAGMATIC HERNIA COMPLICATED WITH AN EARLY CANCER IN THE STOMACH

Abstract

A 76-year-old woman was referred to the hospital because of nausea. Plain X-ray films of the chest and abdomen showed a marked pool of gas and fluid level in the right thoracic cavity and left subdiaphragmatic region. Gastrointestinal radiography disclosed the prolapse of the gastric antrum and the transverse colon into the right thoracic cavity via the right parasternal hiatus-signs suggestive of Morgagni's diaphragmatic hernia. Gastrofluoroscopy revealed an irregular-shaped ulceration of the pyrolic region. Endoscopically this lesion was definitely diagnosed as poorly differentiated adenocarcinoma. Operation was performed by abdominal approach. The herniated organs were returned into the abdominal cavity via the Morgagni's foramen, and hiatus was closed. Subsequently extended gastrectomy and lymph node dissection were performed. In our search for the literature, a total of 231 cases of Morgagni's diaphragmatic hernia were reported up to 1990 in Japan. As for Morgagni's diaphragmatic hernia complicated with malignant tumor, only two cases have been reported so far. However the present case of Morgagni's diaphragmatic hernia complicated with cancer in the herniated stomach is the first case of its kind. The case presented here suggests the possibility of complication with malignant tumor of the herniated organs in the treatment of Morgagni's diaphragmatic hernia in adults.