Morgagni Diaphragmatic Hernia Research Articles

Previously unrecognized Morgagni’s hernia presenting with bowel obstruction: a rare case report

Introduction and importance: Morgagni’s hernia (MH) is a rare entity, it is defined by the protrusion of abdominal viscera through an anterior retrosternal diaphragmatic defect. It is mainly diagnosed during the perinatal and neonatal periods. A few cases have been reported in adults. The objective of this study was to report the case of a patient with an unrecognized MH, review the current literature on Morgani hernias in the adult population, and assess their clinical characteristics and therapeutic approach reported in adults. We here describe a rare case of a MH presenting with bowel obstruction as the primary symptom in adult life. Case presentation: A 52-year-old man presented to the emergency department with a bowel obstruction. The abdominal CT tomography showed an intestinal bowel obstruction above the hiatal hernia with an intrathoracic ascending colon. Exploratory laparotomy revealed a bilateral strangulated diaphragmatic hernia of Morgagni. The patient underwent closure of the diaphragmatic defect under tension by X-stitch. The recovery was uneventful, and the patient is in good health after 12 months of follow-up. Clinical discussion: The Morgagni hernias are usually asymptomatic; complications such as strangulation of the herniated colon or herniated stomach by stricture are exceptional. Surgical treatment is always recommended for MH. Postoperative complications are rare in simple diaphragmatic hernias, and the course is generally favorable. Conclusion: MH is the rarest form of congenital diaphragmatic hernia, with nonspecific symptomatology contributing to the delay in diagnosis. The cure is surgical, and the open surgical approach is preferable in emergency cases, while laparoscopic surgery is favored in elective settings and is associated with shorter hospitalization. Further studies are crucial in order to elucidate etiology and optimal therapeutic approach.

Anaesthetic management of diaphragmatic hernia in elderly woman: A case report

Anteromedial sub costosternal defects, also referred as Morgagni diaphragmatic hernia, is the potentially life-threatening herniation of the abdominal contents into the thorax. Being only a small fraction of all types of congenital diaphragmatic hernias, precise diagnosis of Morgagni Hernia is often deferred, owing to the nonspecific associated respiratory and gastrointestinal symptoms. Once recognized, the primary management for both symptomatic and asymptomatic cases are surgical repair as there is increased risk of strangulation of hernia contents. Various abdominal and thoracic surgical repair approaches have been described. Cardiopulmonary compromise due to the hernial content’s mass effect on heart, lungs, and risk of strangulation poses a great challenge to anaesthesiologists. This case highlights the key feature of the effective anaesthetic management of adult-onset Morgagni hernia posted for laparoscopic repair.

Doctor, My Chest is Deformed…..

Congenital chest wall deformities occurred in roughly 1% of children and if asymptomatic are often overlooked and taken lightly. This results in a progressive deformity of the chest and delays in diagnosis of the underlying causes. Complications can also develop from the underlying condition. Chest wall deformities are associated with a number of syndromes and other anomalies including abnormalities of the diaphragm. Congenital Diaphragmatic Hernia (CDH) is one of the underlying causes of chest deformity. Congenital Morgagni Hernia (CMH) is a rare form of CDH and consists of 3-5% in all CDH. Many cases were delayed in diagnosis due to the subtle presentation or were incidental findings. The consequence of delay in diagnosis can lead to the onset of complications which carries morbidities and even mortality. We report a case of a child with missed diagnosis of a rare condition Morgagni Diaphragmatic Hernia presenting with chest deformity.

Unexpected Encounter of Rare Large Intestinal Obstruction: Morgagni’s Diaphragmatic Hernia

Introduction: Morgagni diaphragmatic hernia only makes up 3-4% of all diaphragmatic hernia cases.

Laparoscopic management of symptomatic congenital diaphragmatic hernia of Morgagni in the adult.

Currently, there is a relative paucity of literature regarding the management of symptomatic congenital diaphragmatic hernia of the foramen of Morgagni in the adult. This study aims to describe our unique surgical technique and outcomes in adult patients undergoing laparoscopic repair of symptomatic Morgagni hernia. This is a retrospective review of adult patients from 2003 to 2020 who underwent a laparoscopic Morgagni hernia repair at our institution. All patients underwent a similar laparoscopic approach, utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect and mesh reinforcement with permanent mesh if the primary repair was subjectively under tension. The study population consisted of 12 consecutive patients with a Morgagni hernia. Patients presented with a variety of symptoms attributed to the hernia, including pain 83% (n = 10), respiratory symptoms and shortness of breath 58% (7), and gastrointestinal obstruction 25% (3). Other complaints included: nausea 33% (4), reflux 50% (6), early satiety 8% (1), palpitations 16% (2), a gurgling sensation in the chest 8% (1), and weight loss 8% (1). Primary repair was possible in all patients following complete reduction of hernia contents including the hernia sac. Mesh reinforcement was used in 5 of 12 patients. Average surgical operative time was 93 (± 37) min. Median length of stay was 1.3days (range 0.5-5.5days). At a median follow-up of 10.9months (IQR 8.0-41.5months), all symptoms attributed to the hernia had resolved. No recurrences were identified. Adults with symptomatic Morgagni hernia should undergo surgical repair. A laparoscopic approach utilizing the surgical principles of reduction of intra-abdominal contents, complete resection of the hernia sac, followed by primary repair of the hernia defect (when possible), with or without mesh reinforcement can be performed safely and effectively.

Acquired Morgagni diaphragmatic hernia and pericardial hernia after cardiac surgery

Acquired anterior diaphragmatic hernia (ADH) is usually the result of thoracic trauma. Acquired Morgagni-type anterior diaphragmatic hernia is a rare complication after cardiac surgery, especially with associated pericardial hernia. We will present a patient with acquired Morgagni-type hernia and pericardial hernia presumably after previous cardiac surgery successfully treated with laparoscopic Morgagni hernia reduction and repair with mesh onlay as well as prophylactic laparoscopic appendectomy, open epigastric hernia repair, and open umbilical hernia repair.

P705 Is chest wall deformity a serious issue? A rare case of TGFBR1 mutation in the paediatric population

Abstract INTRODUCTION Mutations in the genes encoding transforming growth factor β receptors 1 and 2 (TGFBR1 and TGFBR2) have recently been found in association with a continuum of clinical features. Mild association – a presentation similar to that of Marfan"s syndrome. Severe association – a complex phenotype in which aortic dissection or rupture commonly occurs in childhood and at aortic diameters, that ordinarily would not be predictive of these events. Classified as the Loeys–Dietz syndrome. Is chest wall asymmetry a serious issue? A study of 71 patients with Loeys-Dietz – 9% died from aneurysm rupture or dissection with aortic diameters of less than 4.5cm and as early as 6 months of age. Genetic variants of unknown clinical significance - how should they be managed? CASE History 3-year old girl seen in general paediatric clinic with 5 months history of worsening chest wall deformity. Examination Asymmetrical pectus deformity. Spinal asymmetry and soft systolic murmur at the lower left sternal edge. INVESTIGATION Chest x-ray: Grossly enlarged and distorted cardiac/mediastinal silhouette. Echocardiogram Massive ascending aortic root dilatation (5.5cm) with significant aortic regurgitation. MRI whole body angiogram Massively dilated aortic root and ascending aorta to the proximal arch, hugely tortuous and ectatic cerebral vessels, diffuse marked dural ectasia, asymmetrical pectus deformity and a diaphragmatic morgagni hernia in the lower right hemi thorax. Genetic analysis Heterozygous missense variant of unknown clinical significance in exon 3 of TGFBR1 gene. The first heterozygous missense variant of its kind in the paediatric population for which its clinical significance remains unknown. TREATMENT As risk of dissection, a Bentall procedure was performed. Family screening - Father has a dilated proximal ascending aorta. LEARNING POINTS Chest wall deformity should prompt clinicians to expedite investigations for aortic root dilatation/aneurysm and connective tissue disorders. The continuum of clinical features of these genetic associations emphasises the importance of early recognition of the phenotype, prophylactic intervention and meticulous surveillance of the distal aorta and vascular tree for optimal management. A genetic variant of uncertain significance (VUS) should not be used in clinical decision making. Efforts to resolve the classification of the variant as pathogenic or benign should be undertaken with good working relationships with clinical geneticists. A VUS is difficult for patients and parents to understand and may also cause psychological distress. The importance of careful clinical and molecular characterisation to identify patients and families at risk cannot be overemphasised. This allows the use of a structured approach to intervention, informed counselling regarding the risk of recurrence, concerns related to pregnancy, and guidelines for clinical management. Abstract P705 Figure. Case Photography and Imaging

Laparoscopic treatment of Morgagni hernia

We report a case of diaphragmatic hernia of Morgagni with a unique clinical presentation. It is important to know all the possible complications and acute presentations of Morgagni hernia. Before the innovation of laparoscopy in the treatment of diaphragmatic hernia, it is used to be treated either through abdominal approach or, in most cases, thoracic approach.

Laparoscopic Approach in Correction of Adult Diaphragmatic Morgagni Hernia

Introduction. Adult hernia of Morgagni is a very rare congenital anomaly. Therefore, to date there is no standard surgical techniques used in the management. Thus, a systematic review aimed to find the highest evidence in the management. Method. A systematic review conducted in accordance with PRISMA. Literature search proceeded on PubMed and ScienceDirect using keywords diaphragmatic hernia of Morgagni in adult, and treatment. These articles were reviewed and appraised for the study design used, enrolled samples, validation of results, etc. to find out the level of evidence. The analysis was focused on length of stay, the recurrence, and complications. Results. There were 15 articles analyzed. The transabdominal approach provides better exposure, short length of stays, and low complications. Laparoscopic has been used widely and replaces open surgery. The defect closure using mesh is indicated in large defect of ≥20cm2. The hernial sac is unnecessary to resect, with no complication such as seroma or recurrence. Conclusion. A laparoscopic approach referred to the method of choice in the management of adult hernia of Morgagni. Unnecessary resection of hernial sac and tension free defect closure should be of one consideration

THREE PORTS LAPAROSCOPIC REPAIR OF ADULT MORGAGNI HERNIA AND RARE SIMULTANEOUS PRESENTATION OF PARA-ESOPHAGEAL HERNIA WITH MORGAGNI HERNIA

We report two case reports of Morgagni hernia repair. Our first case was on 65 year old white male who presented with abdominal pain in right upper quadrant and right side of chest for last 3 days. He was having 3 episodes of dark appearing vomiting associated with pain. He also had two episodes of hematemesis. Patient had gastric outlet obstruction with severe distension of stomach because of incarcerated small bowel and colon in the right sided anterior diaphragmatic Morgagni hernia. Laparoscopic repair of incarcerated Morgagni hernia under general anesthesia was planned. We report our second case on rare simultaneous presentation of Morgagni Hernia with type 3 Para esophageal hernia. 60 years old female patient presented in clinic with a follow up of chest discomfort which was progressively increasing with shortness of breath and a chronic gastric reflux. Her vitals were within normal limits and had body mass index (BMI= 29.52kg/m2) (overweight category). Previous past medical history included multiple episodes of gastric regurgitation and cardiovascular intervention for coronary stenting. CT scan showed type 3 paraesophageal hernia (gastro esophageal junction with fundus of stomach displaced above diaphragm). The patient had more than 30% of her stomach incarcerated in the chest as a paraesophageal hernia. The gastro esophageal junction was intra-abdominal after lysis of adhesion. Mesh was placed after posterior crural repair, followed by Nissen fundoplication over a 54 French bougie patient also had an incidental finding of a reducible Morgagni hernia through an anterior defect, followed by a repair without mesh. Esophago-gastro-duodenoscopy showed there was no evidence of any air leak with good valve creation on retroflexion through a fundoplication.

Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients.

This study aimed to standardize the surgical correction technique of congenital Morgagni diaphragmatic hernia (CMDH), analyzing the results of an international multicentric survey. The medical records of 43 patients (29 boys, 14 girls) who underwent laparoscopic repair of CMDH in 8 pediatric surgery units in a 5-year period were retrospectively reviewed. Their average age was 3.3years. Ten patients (23.2%) presented associated malformations: 9 Down syndrome (20.9%) and 1 palate cleft (2.3%). Thirty-five patients (81.4%) were asymptomatic, whereas 8 patients (18.6%) presented symptoms such as respiratory distress, cough or abdominal pain. As for preoperative work-up, all patients received a chest X-ray (100%), 15/43 (34.8%) a CT scan, 8/43 (18.6%) a barium enema and 4/43 (9.3%) a US. No conversion to open surgery was reported. Average operative time was 61.2min (range 45-110min). In 38/43 (88.3%) patients, a trans-parietal stitch was positioned in order to reduce the tension during the repair. In 14/43 cases (32.5%), the sac was resected; in only 1/43 case (2.3%) a dual mesh of goretex was adopted to reinforce the closure. Average hospital stay was 2.8days. The average follow-up was 4.2years, and it consisted in annual clinical controls and chest X-ray. We recorded 2 complications (4.6%): one small pleural opening that required no drain and one recurrence (2.3%), re-operated in laparoscopy, with no further recurrence. To the best of our knowledge, this is the largest series published in the literature on this topic. Laparoscopic CMDH repair is well standardized: The full-thickness anterior abdominal wall repair using non-resorbable suture with interrupted stitches is the technique of choice. Postoperative outcome was excellent. Recurrence rate was very low, about 2% in our series. We believe that children with CMDH should be always treated in laparoscopy following the technical details reported in this paper.

Пізно виявлені природжені діафрагмальні грижі Морганьї: діагностика та хірургічна корекція у дітей

Пізно виявлені природжені діафрагмальні грижі Морганьї: діагностика та хірургічна корекція у дітей

Waxing and Waning Congenital Diaphragmatic Hernia of Morgagni: A Diagnostic Conundrum

A 3/2-year-old healthy girl who had swallowed a metal screw was admitted in our institution (Figure 1A). Surprisingly, the thoracoabdominal radiograph (TAR) revealed the presence of an intrathoracic herniation of intestinal loops consistent with a diaphragmatic hernia (DH). The screw was retrieved gastroscopically. Further evaluation with a barium contrast swallow study revealed normal proximal intestinal anatomy and timely contrast advancement through the duodenojejunal flexure to the terminal ileum (Figure 1B). The distal portion of the terminal ileum was anomalously located in the upper right abdominal quadrant, and the cecum and ascending colon were visualized above the diaphragm in the right hemithorax, confirming the presence of a DH (Figure 1B). Because the child was asymptomatic, elective surgery was scheduled 4 days later. Unexpectedly, a repeat preoperative TAR showed no evidence of intrathoracic

Congenital Hernia of Morgagni - A Case Report

Congenital Diaphragmatic Hernia of Morgagni occurs through the foramen of Morgagni, is rare in children. It is usually asymptomatic and detected accidentally. If symptomatic, then symptoms are variable and nonspecific making diagnosis difficult . Our patient presented with signs and symptoms suggestive of congenital heart disease, gastroesophageal reflux disease and recurrent pneumonia.

Congenital Hernia of Morgagni - A Case Report

Congenital Diaphragmatic Hernia of Morgagni occurs through the foramen of Morgagni, is rare in children. It is usually asymptomatic and detected accidentally. If symptomatic, then symptoms are variable and nonspecific making diagnosis difficult . Our patient presented with signs and symptoms suggestive of congenital heart disease, gastroesophageal reflux disease and recurrent pneumonia.

Nontraumatic Liver Herniation through a Right–Sided Congenital Diaphragmatic Hernia of Morgagni: An Autopsy Case Report with a Review of Liver Herniations through the Defect and a Review of the Defect

Congenital diaphragmatic hernia of Morgagni (CMH) is a rare developmental defect that develops during the development of the human diaphragm. It is usually right-sided and tends to produce symptoms in later life when abdominal viscera herniate into the chest cavities. Herniations of the liver through this defect into the chest cavities are rare and are often not clinically suspected even when they are associated with symptoms. The amounts of liver tissue involved are usually small, do not cause symptoms and are often an incidental finding during imaging studies of the chest for unrelated symptoms. This case report documents a clinically unrecognized incidental herniation of the liver into the right chest cavity through a CMH. The report also reviews previously reported cases of liver herniations through a CMH and the possible causes of the defect.

Repair of a bilateral Morgagni hernia in a premature, extremely low birth weight infant

Congenital diaphragmatic hernias (CDH) are rare congenital anomalies occurring in 1:5000 live births with a wide range of clinical presentations. The Morgagni hernia is the rarest of these defects with the hernia presenting anteriorly, most commonly on the right. Factors found to predict mortality in infants presenting with CDH include prenatal diagnosis, early gestational age, low birth weight, large diaphragmatic defect, associated congenital anomalies, and low APGAR scores. We present the case of a 27-week gestational age premature girl weighing 460 g who required urgent repair of a Morgagni diaphragmatic hernia and a review of the current literature on the topic. To the best of our knowledge, this is the smallest infant to undergo repair of this CDH reported to date.

Successful management of incarcerated Morgagni's diaphragmatic hernia in a 62-year-old man

Successful management of incarcerated Morgagni's diaphragmatic hernia in a 62-year-old man

Recurrence rate of Morgagni diaphragmatic hernia following laparoscopic repair

Morgagni diaphragmatic hernia can be repaired laparoscopically. The aim of this study is to evaluate the outcome of this minimally invasive approach. A retrospective review was conducted on all consecutive children who underwent repair of Morgagni hernia from January 2002 to December 2011 in our hospital. Data are expressed as median (range). There were 12 children with Morgagni hernia. Age at surgery was 7.5months (2-125). Associated malformations were present in 7 children (58%). All children underwent initial laparoscopic approach. Two children (16%) underwent conversion to open surgery. The hernia was closed primarily in 11 children (92%), using a polyester patch in 1 (8%). There were no intraoperative or immediate postoperative complications. Five children (42%), all repaired initially without a patch, had a recurrence of the Morgagni hernia. The repair of the recurrent hernia was performed laparoscopically in four out of the five children, and a patch was used in two patients with no further recurrences or complications. There is a high rate of recurrence after laparoscopic Morgagni hernia repair. This is exclusively associated with laparoscopic repair without patch, and it is in contrast with the low recurrence rate reported previously. More frequent use of patch may be beneficial.

Laparoscopic repair of Morgagni diaphragmatic hernia in infants and children

Purpose Removal of the hernia sac for Morgagni diaphragmatic hernia repair in infants and children is a controversial issue. In our series, we elected not to excise the sac in all the cases. Methods Nine children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair without excision of the hernia sac, and we analyzed our results, complications, and outcome. Results Between January 2007 and March 2011, nine children, comprising five boys and four girls, with Morgagni hernia underwent repair laparoscopically at our hospital. The mean age of the children was 15.1 months (range, 3–38 months), mean operative time was 50.5 min, and mean hospital stay was 3.6 days. There were no intraoperative or postoperative complications. The mean follow-up time was 32.8 months (range, 6–54 months). There were no recurrences. All patients had complete obliteration of the residual cavity. Conclusion Laparoscopic closure of the defect by suturing the posterior rim of the hernia to the full thickness of the anterior abdominal wall without excision of the hernia sac is safe and effective in repairing Morgagni hernia without any risk accruing from leaving the hernia sac intact. Keywords: laparoscopic Morgagni hernia repair, Morgagni diaphragmatic hernia, retrosternal diaphragmatic hernia