|Year : 2020 | Volume
| Issue : 1 | Page : 64-66
Laparoscopic treatment of Morgagni hernia
Bandar Saad Assakran1, Shaima Abdullah Alharbi2, Fadiyah Abdullah Alharbi2
1 Department of Surgery, King Fahad Specialist Hospital, Buraydah, Kingdom of Saudi Arabia
2 Interns at the College of Medicine, Qassim University, Buraydah, Qassim, Kingdom of Saudi Arabia
|Date of Submission||24-Apr-2020|
|Date of Acceptance||15-Dec-2020|
|Date of Web Publication||19-Jan-2021|
Dr. Bandar Saad Assakran
Department of Surgery, King Fahad Specialist Hospital, P.O. Box 2290, Buraydah 81999
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
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.
Keywords: Diaphragmatic hernia, hernia, laparoscopy, Morgagni hernia, treatment diaphragmatic hernia
|How to cite this article:|
Assakran BS, Alharbi SA, Alharbi FA. Laparoscopic treatment of Morgagni hernia. Saudi Surg J 2020;8:64-6
| Introduction|| |
Giovanni Battista Morgagni discovered the diaphragmatic hernia when he was performing an autopsy to a patient who died from a head injury. The structure of the diaphragm consists of a costal, sternal, lumbar, and membranous portion that contributes to the development of hernia.
This type of hernia occurs as a result of a congenital defect in the diaphragm between the sternal and costal part. Morgagni hernia accounts for 3% of all diaphragmatic hernias; hence, it is considered to be one of the least common types of hernias. A right-sided Morgagni Hernia is more common than a left-sided hernia (95%).
Review studies about diaphragmatic hernias are not many. Articles between 1951 and 2008 were found by Horton et al. and reported diaphragmatic hernias in 298 patients, of them 72% had symptoms regarding the diaphragmatic hernia. Thirty-six percent of the patients had respiratory complaints, which were the most common symptoms. Male patients had, in the past, a higher incidence of developing Morgagni hernia earlier than in female patients. Morgagni hernia is broadly treated through thoracic approach (49%). Women represented 62% of patients with Morgagni hernia, with an average age of 53 years. Male patients were presented at an average age of 50 years. Morgagni hernias could be asymptomatic or could present with nonspecific respiratory or digestive symptoms; this leads to a late diagnosis of the majority of the cases.
We report a case of successful laparoscopic repair of a Morgagni hernia with a placement of dual mesh. Laparoscopic operations allow earlier return to physical activity and frequently result in reduced postoperative pain and shorter hospital stay.
| Case Report|| |
The patient is a 56-year-old female, known case of diabetes mellitus and obesity, and she was on oral hypoglycemic agent. She was admitted to the emergency department at King Fahad Specialist Hospital as case of atypical pneumonia. The patient presented with a history of shortness of breath and cough.
She was investigated and chest X-ray was done; it showed right-sided lung opacity. The patient was then isolated and computed tomography (CT) of the chest was processed [Figure 1]. The results showed a right-sided diaphragmatic hernia which contained the transverse colon.
|Figure 1: CT chest finding: Herniated transverse colon in the right chest|
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| Discussion|| |
The patient was admitted to the surgical ward and was planned for laparoscopic repair of the diaphragmatic hernia with dual mesh.
Intraoperative finding was a 3 cm × 3 cm defect in the right side of the diaphragm [Figure 2]; the sac contained around 15 cm of transverse colon and omentum, which were severely adherent to the sac. The contents were reduced and a 5 cm × 5 cm dual mesh was used to close the defect; metallic staples were used to fix the mesh to the diaphragm [Figure 3].
|Figure 2: Laparascopic view of the defect before and after reducing the content (transvere colon)|
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|Figure 3: View after reducing the content and placing the dual mesh covering the defect|
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The operation took 1 h and 50 min, and the postoperative period was uneventful. Oral intake was initiated day 1 postoperatively, and the patient was discharged home on day 2 postoperatively.
The first follow-up was after 2 weeks from the operation and the follow-up CT is shown in [Figure 4]. The patient felt well and had no complaints.
|Figure 4: CT scan of the chest after 1 month showing the cavity filled with fluid and no herniation of intraabdominal organ|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Soldo I, Baća I, Sever M, Zoričić I, Grbavac M, Perić R i sur T. Laparoscopic treatment of Morgagni hernia: Report of three cases. Acta clinica Croatica 2017;56:318-22.
Shah RS, Sharma PC, Bhandarkar DS. Laparoscopic repair of Morgagni's hernia: An innovative approach. J Indian Assoc Pediatr Surg 2015;20:68-71.
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Horton JD, Hofmann LJ, Hetz SP. Presentation and management of Morgagni hernias in adults: A review of 298 cases. Surg Endosc 2008;22:1413-20.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]