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Laparoscopic repair of strangulated Morgagni hernia

DOI: 10.1186/1749-7922-2-27

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Abstract:

Morgagni hernia is a rare diaphragmatic hernia that develops through a congenital retrosternal defect. In adults they are generally asymptomatic and are found incidentally during laparoscopy or imaging for another condition. However, they may present as an emergency with abdominal pain due to strangulation of the hernia contents. An unusual case is reported of a strangulated Morgagni hernia, which presented with vomiting and abdominal pain due to a gastric volvulus.A 73-year-old man presented with a 24-hour history of vomiting and severe, constant epigastric pain. In the preceding three months he had noticed intermittent, dull epigastric pain worse on lying flat. He suffered from type II diabetes, hypertension, asthma and intermittent claudication. He had previously undergone treatment for a transitional cell carcinoma (TCC) of the bladder and repair of umbilical and inguinal hernias. He was a retired electrician with previous asbestos exposure and he was an ex-smoker. On examination, he was tachycardic and pyrexial with a distended, generally tender abdomen but no signs of peritonitis. Respiratory examination was unremarkable and his blood tests showed a raised white cell count (16.1 × 109/L) along with raised serum creatinine (189 μmol/L) and urea (11.9 mmol/L). Chest x-ray showed an unusual air fluid level in the lower chest (fig 1). Under fluoroscopy, a fine bore tube was inserted and a gastrografin? (Schering AG, Germany) study was done (fig 2, 3). This showed a gastric volvulus with complete obstruction within a Morgagni hernia.An emergency laparoscopy was done via open insertion of a 10 mm port at the umbilicus and subsequent insertion of two 5 mm ports. The stomach, transverse colon and omentum were trapped in the hernia (fig 4). They were reduced with difficulty after incising the neck of the sac and the edge of the diaphragmatic defect (fig 5). There was a large section of necrotic omentum, which was resected and placed into a retrieval bag and subsequentl

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