Foramen Of Morgagni Research Articles

“Mediastinal Pseudocyst: A Case Report and Review of Literature”

A mediastinal pseudocyst is the extension of pancreatic pseudocyst into the posterior mediastinum through esophageal or aortic hiatus or rarely through the foramen of Morgagni. It is a rare complication of acute or chronic pancreatitis. We report a rare case of mediastinal pseudocyst of a 35-year-old male alcoholic who was presented with dyspnea, hemoptysis.

Laparoscopic repair of an incarcerated Morgagni Hernia in a COVID-19-positive patient: A video case report

IntroductionMorgagni Hernia (MH) is a type of congenital diaphragmatic hernia (CDH). CDH is a diaphragmatic discontinuity that permits abdominal viscera to herniate into the chest during development. It does not only occur in early childhood but also has been reported in adults. The most prevalent clinical sign of MH is respiratory disorder of all ages.Case presentationAn elderly woman with a known history of diabetes, ischemic heart disease, hypertension, and constipation presented to us with increased abdominal pain. Besides, her PCR test results were positive for COVID-19. She underwent diagnostic laparoscopy surgery. The incision was closed with an intracorporeal suture, and then dual mesh was fixed to diaphragmatic wall. The postoperative progress was satisfactory two weeks after surgery. Based on a negative PCR test, the patient was discharged from the hospital.DiscussionThe foramina of Morgagni is a defect in the costosternal trigons produced by a lack of anterior pleuroperitoneal membrane muscularization. Although gastrointestinal symptoms and cardiorespiratory discomfort are typically connected with the diagnosis and treatment of MH in youngsters, there are a few middle-aged people who, like our case, develop symptoms suddenly. Albeit a paradigm change in the 21st century deems less invasive laparoscopic surgery to be the treatment of choice, open surgical procedures via a trans-thoracic or trans-abdominal route are still used.ConclusionMH is indeed uncommon in adults, but in patients with an acute onset of intestinal obstruction, the possibility of MH should be in mind. It can be fatal if it is misdiagnosed.

Gallbladder Torsion with Incarceration into the Foramen of Morgagni

Gallbladder Torsion with Incarceration into the Foramen of Morgagni

P171 LAPAROSCOPIC REPAIR OF A GIANT MORGAGNI’S HERNIA PRESENTING WITH RESPIRATORY DISTRESS

Abstract Background Morgagni hernias are a rare entity among diaphragmatic hernias, representing 2% of all cases. Although uncommon, it can be fatal if the diagnosis is missed. Foramen of Morgagni is a triangular space located between the muscular fibers of the xiphisternum and the costal margin fibers that insert on the central tendon of the hemidiaphragm. They usually present in childhood with respiratory symptomatology, and a majority of cases in adults are detected incidentally on chest radiographs. Aims/Scope To present an extremely rare case of acute dyspnea caused by a giant congenital Morgagni’s hernia, together with review the diagnostic algorithm and the role of surgical treatment. Results A 48-year-old caucasian male, previously healthy, was referred to our department with acute onset dyspnea and vague right-sided chest pain for the past 4 months. No history of chest or abdominal trauma was mentioned. Chest examination revealed bowel sounds and decreased air-entry in the right chest. The patient was offered a laparoscopic repair; at operation, jejunum, ileum, appendix, ascending and transverse colon to its distal two thirds with the associated omentum were found within the hernia sac. Hernia’s neck was bridged with a dynamesh IPOM mesh in a tension free manner. The patient is well and symptoms free at 1 year follow up. Conclusion Majority of Morgagni hernias are diagnosed late because patients are either asymptomatic or present with nonspecific gastrointestinal or respiratory symptoms. Controversy exists regarding operative approaches via either transabdominal route or transthoracic route. In our case, laparoscopic repair was offered with favorable outcome.

Single site laparoscopic repair of a Morgagni hernia in a pediatric patient

Abstract Anterior diaphragmatic hernias through the foramen of Morgagni are rare accounting for about 3% of surgically treated diaphragmatic hernias. Current management of Morgagni type diaphragmatic hernias involves surgical intervention, which is traditionally done by open laparotomy, laparoscopy or thoracoscopic approach. Here we present the case of a two year old female with a Morgagni type congenital diaphragmatic hernia (CDH) found during work-up for an upper respiratory infection, repaired using a single site laparoscopic primary approach.

Emergency surgery for a Morgagni hernia causing respiratory failure

Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s general condition improved thereafter, and he was discharged on postoperative day 29.

A huge Morgagni hernia with compression of the right ventricle

A 21 year old male with no relevant medical history presented to our Institution for further assessments of a right paracardiac mass founded on a chest X-ray. Chest computed tomography revealed a wide median defect of the diaphragm at the level of xiphoid process of the sternum, with the herniation of omental fat tissue in the mediastinum. Cardiac magnetic resonance confirmed the presence of a huge hernia originating from the foramen of Morgagni (sterno-costal hiatus), displacing the heart leftwards and posteriorly and compressing the right ventricle (RV), giving to it a tubular shape.The signal characteristics were typical of fat tissue, with hyperintense signal in T1 and T2 weighted black blood images and homogeneus signal suppression on STIR T2 black blood images. Short axis real time cine images, performed during deep inspiration, showed an early diastolic ventricular septal bounce, with flattening of the interventricular septum during mid-late diastole: they represented signs of diastolic dysfunction of the right ventricle, resembling a sort of “pseudo-constrictive” pathophysiological model. The patient was thus referred to surgical repair of the diaphragmatic defect.

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.

Left-sided foramen Morgagni hernia repair

Clinically evident hernia through the foramen of Morgagni is uncommon at any age. It is rarest of all the diaphragmatic hernias and incidence is 3–4 % of all the diaphragmatic hernias. About 90 % of Morgagni hernia occurs on the right, 8 % bilateral, and only 2 % are limited to the left. A 10-year-old child was referred to us with complaints of shortness of breath on exertion and repeated lower respiratory tract infections since age of 1 year. X-ray chest showed bowel loops in the left side of chest makes a diagnosis of diaphragmatic hernia. Computerized tomogram scan of the chest showed a large defect anteriorly retrosternally on left side herniating the small bowel, large bowel, and spleen in the left chest, and the left lung was hypoplastic. Surgical repair was done through the left thoracoabdominal approach and was repaired using polypropylene mesh. Postoperative recovery was uneventful. We are reporting this case because of a rare and unusual presentation in this patient. Foramen of Morgagni hernias are detected more often in women than in men and more often in obese people than in those of average or below-average weight. Our case was a young, underweight, male child.

腹腔鏡下修復術を施行した食道裂孔ヘルニアとMorgagni孔ヘルニア併存の1例

腹腔鏡下修復術を施行した食道裂孔ヘルニアとMorgagni孔ヘルニア併存の1例

CSF Hydrothorax as a Late Complication of Ventriculoatrial Shunt Catheter Displacement.

A 21-year-old man was admitted to our emergency department with chest pain and progressively increasing dyspnoea commencing 1 week previously. His self-history revealed that he had received a ventriculo-atrial shunt at the age of 2 weeks due to congenital hydrocephalus (Figure 1a). At physical examination, no breathing sounds were heard on the right side. Neurological examination was normal. Total blood counts and C-reactive protein (CRP) were within normal limits. Chest X-ray showed right-sided hydrothorax and a catheter tip at the right thoracic apex (Figure 1b). The patient was transferred to the neurosurgery department. A consultation was held with the thoracic department. Thoracentesis was performed 3 times in 1 week, but the hydrothorax still persisted (Figure 1c). Subsequent removal of the ventriculo-atrial shunt catheter with disconnection on the scalp was performed. The distal tip of the catheter was left in the vessel. Symptoms improved rapidly. Chest X-ray revealed resolution of pleural effusion and re-expansion of the right lung (Figure 1d, e). Recovery was uneventful and no further thoracentesis or new shunt catheter were required. The patient was discharged 7 days later in good condition. The patient has remained in good clinical condition at the 2-year follow-up, and hydrocephalus has been arrested. FIG. 1. a-e. The patient’s cranial computed tomography (CT) shows the ventricular shunt catheter at the right lateral ventricle (a); Chest X-ray shows right sided hydrothorax (b); Chest X-ray after thoracentesis shows persisting hydrothorax (c); Chest X-ray ... We suggest that the shunt catheter may migrate from the intravascular space to the thoracic cavity through the area of entry into the internal jugular vein near the brachiocephalic trunk as a result of age-related upward pull. This was suggested by the catheter position in the right thoracic apex. The absence of bleeding into the thoracic cavity while the catheter tip was being exvasated may be attributed to the process having occurred over an extended period. The vessel wall was therefore repaired during this long period. Complications of ventriculoperitoneal or ventriculo-atrial shunts commonly occur due to obstruction, disconnection or infection (1–3). There are some reports of hydrothorax as a complication of ventriculoperitoneal (V-P) shunting (4). Taub et al. (5) classified V-P shunt thoracic complications into three types: 1) intrathoracic trauma during shunt replacement, 2) peritoneal catheter migration into the thoracic cavity, and 3) pleural effusion with cerebrospinal fluid (CSF) ascites. The peritoneal catheter may migrate into the thoracic cavity in either a supradiaphragmatic or transdiaphragmatic manner. In supradiaphragmatic migration, the peritoneal catheter is accidentally inserted into and out of the pleural cavity during the tunnelling procedure, especially at the supraclavicular fossa, which is the most dangerous area (6, 7). In transdiaphragmatic migration, the peritoneal catheter is gradually pulled into the thoracic cavity due to the negative pressure effect of inspiration. Increased intra-abdominal pressure due to peritoneal malabsorption also facilitates this process (5). The peritoneal catheter may migrate from a pre-existing hiatus into the diaphragm or may perforate it. Congenital hiatuses or weak points in the diaphragm are areas where the peritoneal catheter tip may pass into the thoracic cavity. Local inflammation around the peritoneal catheter tip may also facilitate the passage of the shunt tip through the diaphragm (4, 6). Hydrothorax may sometimes occur in association with CSF ascites. Peritoneal malabsorption leads to excessive CSF collection in the peritoneal cavity. CSF may pass through the thoracic cavity via congenital hiatuses (foramen Bochdalek or foramen of Morgagni) with increased intra-abdominal pressure (6). Ventriculo-pleural shunts have only been used infrequently for hydrocephalus. CSF hydrothorax is also one of the serious thoracic complications of ventriculo-pleural shunts (8). In particular, the long-term results are less satisfactory for ventriculo-pleural shunts, because shunt obstruction or pleural effusions are most frequently developed in 3 years (8). The late hydrothorax complicating the ventriculo-pleural shunts can be explained by two hypotheses: (a) Decreased CSF absorption in the pleural space as a result of impaired pleural absorptive capacity secondary to pleural damage due to prior infection and/or chronic exposure to CSF and (b) over-drainage of CSF into the pleural space (8, 9). The present case behaved as a ventriculo-pleural shunt due to prolonged drainage of CSF into the pleural space from the right thoracic apex. The possible mechanisms of hydrothorax formation in our patient with ventriculo-atrial shunts are the same as those in ventriculo-pleural shunt. To the best of our knowledge, this is the first reported case of CSF hydrothorax as a late complication of ventriculo-atrial shunt catheter displacement. We therefore wish to report this unique complication of ventriculo-atrial shunt.

Cardiac Tamponade as a Complication of Pseudocyst in Chronic Pancreatitis

Case Report: A 45-year-old male with history of alcoholism and chronic pancreatitis presented to the emergency department with chief complaint of chest pain and shortness of breath. On physical exam, he was in severe distress, with distended neck veins, distant heart sounds, and bilateral crackles on lung exam. He was hemodynamically unstable with a blood pressure of 80/60 mm Hg and pulse of 110. Pulsus paradoxus with drop in systolic blood pressure on inspiration was also observed. A noncontrast chest CT showed massive pericardial effusion. The effusion was drained urgently and a pericardial drain was left in place. Following which, his blood pressure stabilized at 110/70. Pericardial fluid analysis showed WBC of 3750/mm3 with 97% neutrophils, RBC of 59400/mm3, LDH of 1387 u/L, total protein of 4.8 g/dL, glucose 116 mg/dL, amylase 101 u/L, and lipase 196 u/L. The pericardial drain was removed the next day after decreased output. Within hours, he became hypoxic and hypotensive. CT angiogram of the chest showed reaccumulation of fluid in the pericardium along with bilateral pleural effusions. It also revealed a pancreatic pseudocyst that was found to be extending close to the posterior mediastinum and abating the posterior pericardial wall with a fistulous tract from the pseudocyst into the pericardium. He was intubated due to hemodynamic instability and moved to the ICU. He then had a ERCP followed by an EUS-guided cystogastrostomy to drain the pseudocyst. His subsequent post-op course was uneventful. Discussion: Pseudocyst formation is a common complication of both acute and chronic pancreatitis. Approximately, 40% will resolve spontaneously within 6 weeks. Extra-abdominal extension of a pancreatic pseudocyst is uncommon. Mediastinal pseudocysts result from extension of enzyme rich proteolytic fluid through the diaphragm. Most common route is via the aortic or esophageal hiatus. Rarely, it occurs by direct erosion through the diaphragm or via foramen of Morgagni. Even rarer, does a mediastinal pseudocyst penetrate into the pericardial sac. CT scan, ERCP, and magnetic resonance pancreatogram (MRP) are useful for diagnosis. The treatment modalities include (1) medical management, (2) ERCP with endoscopic pancreatic stent placement (endoscopic transpapillary/transmural technique), (3) surgery, and (4) endosonographic drainage. Conclusion: Pancreaticopericardial fistula should be considered in the differential diagnosis of pericardial effusion in a patient with known history of chronic pancreatitis and should be treated promptly.

Intractable Nausea and Vomiting and Weight Loss in a Young Adult: A Rare Diagnosis to Consider

Introduction: Anteriomedial diaphragmatic defect -Morgagni hernia- accounts for less than 5% of all congenital diaphragmatic hernias (CDH). Presentation can occur in elderly females (sixth decade of life) or in the first decade of life with respiratory, cardiovascular, or gastrointestinal symptoms. Colon, small bowel, liver, and stomach herniation into chest cavity have been reported. Gastric volvulus is an extremely rare presentation. A 35-year-old black male presented with 2-3-month history of persistent postprandial nausea and vomiting, epigastric pain, early satiety, and 25-lb weight loss. Physical exam showed dry mucous membranes, scleral icterus, and decreased air entry to the right lower lung field. Acute abdominal series showed an air-fluid level in the right hemithorax and normal bowel-gas pattern. Computed tomography scan showed partial gastric outlet obstruction due to entrapment of the gastric antrum in a large Morgagni type hernia with partial volvulus. Esophagogastroduodenoscopy (EGD) showed dilated stomach and encountered resistance passing the endoscope past the duodenal bulb. A nasojejunal tube was subsequently placed for decompression. After fluid resuscitation and electrolyte replacement, he underwent laparoscopic reduction of the stomach and mesh repair of Morgagni’s defect. He had a smooth postoperative course and gained 10 lbs at 2-month follow-up. Herniation of abdominal contents into the thoracic cavity through the foramen of Morgagni is a rare clinical condition in adults, accounting for only 3% of all treated diaphragmatic hernias. Gastric volvulus is quite rare, and is classified based on the rotational axis: organoaxial rotation of the stomach along the long axis connecting gastroesophageal junction (GEJ) and pylorus, or mesenteroaxial rotation of the stomach along the short axis connecting lesser and greater curvatures. The latter is less common, and results in antral displacement above the GEJ. Our patient had partial mesenteroaxial volvulus in the setting of Morgagni hernia. While acute presentation is a surgical emergency, chronic presentation, as in our patient, can be managed conservatively or surgically, depending on the severity of their symptoms, life expectancy, and comorbidities. EGD can be diagnostic and therapeutic through endoscopic de-rotation in primary volvulus, but initial management should focus on fluid and electrolyte replacement, gastric decompression with nasogastric tube placement, surgical intervention for hernia reduction, de-rotation of stomach, and defect closure by approximation or mesh repair. Prompt recognition of this condition is imperative, and initial chest and abdominal plain films can point towards this diagnosis.

Gastric Volvulus Through Morgagni Hernia: An Easily Overlooked Emergency

BackgroundIntractable vomiting in an elderly patient is an emergency condition requiring prompt diagnosis and intervention. Acute gastric outlet obstruction due to gastric volvulus through Morgagni-type diaphragmatic hernia is an exceedingly rare cause of this nonspecific complaint. ObjectiveOur aim was to highlight that Morgagni hernia, although rare in adults, should be suspected in the appropriate clinical setting, and that a clue toward diagnosis often comes from routine chest and abdominal x-ray studies. In addition, we emphasize the atypical radiological findings and importance of emergency surgical intervention in such a case. Case ReportWe describe the case of a 78-year-old woman who presented to the Emergency Department with a 4-day history of intractable vomiting, and with no definitive clue to the diagnosis on examination. Her routine chest and abdomen x-ray studies suggested abnormal air-fluid level at right hemithorax, which prompted a computed tomography (CT) scan of the abdomen and an upper gastrointestinal contrast study. Gastric volvulus through a foramen of Morgagni was diagnosed and transthoracic reduction of the contents was performed, along with repair of the defect. ConclusionsA symptomatic Morgagni hernia in adults, although rare, can present with a variety of symptoms ranging from nonspecific complaints of bloating and indigestion to the more severe complaint of intestinal obstruction. Gastric volvulus and obstructive features are less frequently reported as acute complications of these hernias, which need early identification and intervention.

Incarcerated Morgagni Hernia in an Octogenarian with Incidental Right-Sided Colonic Malignancy

We present an incarcerated Morgagni hernia in an octogenarian with incidental right-sided colonic malignancy who was admitted to clinic due to abdominal pain and symptoms of intestinal obstruction. An 85-old male patient had a history of constipation, abdominal distension, pain, vomiting, nausea and radiographic features of bowel obstruction and mediastinal mass in right lower chest. Under suspicion of acute intestinal obstruction due to transverse colon herniation in thorax through Morgagni foramen, emergent laparotomy was performed. Morgagni foramen was located on the right-sided anterior diaphragm and Morgagni hernia which contained of incarcerated transverse colon, greater omentum and 70 cm small bowel after releasing the adhesions was gently reduced. In the same time right-sided colon malignancy was found. Morgagni foramen measuring 7 cm in diameter was sutured first and decompressive bypass ileocolic anastomosis was created. The role of emergent surgery, even in advanced age, is emphasized.

97歳にて発症したMorgagni孔ヘルニア嵌頓の1例

症例は97歳，男性．上腹部痛を主訴に当院救急外来を受診した．腹部単純CTにてMorgagni孔に嵌入する横行結腸と大網を認め，Morgagni孔ヘルニア嵌頓と診断した．疼痛は次第に増強し，ヘルニア内容の血流障害を否定できなかった．一方で超高齢，心筋梗塞・心不全の既往，抗血栓療法中などの高リスクから手術適応の判断に苦慮したが，御家族が手術を希望され緊急開腹となった．手術所見では嵌頓した横行結腸や大網は用手的に還納され，軽度の血流障害を認めるのみであり壊死や穿孔は認めなかった．ヘルニア門は3×3.5cmであり，ヘルニア嚢は処理せず縫合閉鎖のみを行い，短時間にて手術を終了した．術後肺炎を併発したが軽快し自宅退院となり，現在102歳にて存命である．1990年以降本邦で報告されている，超高齢者に発症したMorgagni孔ヘルニア症例において，自験例は13例目，最高齢，唯一の男性であった．

Young Woman With Vomiting, Dyspnea, and Chest Pain

Young Woman With Vomiting, Dyspnea, and Chest Pain

Congenital diaphragmatic hernia: review of current concept in surgical management.

Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.

Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence.