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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgments
 ::  References

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CASE REPORT
Year : 1991  |  Volume : 37  |  Issue : 4  |  Page : 228-30

Obstructed Morgagni's hernia (a case report).


Department of Surgery, Seth G. S. Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
Department of Surgery, Seth G. S. Medical College, Parel, Bombay, Maharashtra.


  ::  Abstract

A forty-year-old male patient was admitted with acute intestinal obstruction, plain X-ray abdomen and chest revealing air fluid levels on the right side of chest. A successful operation was carried out and the patient made an uneventful recovery. Obstructed Morgagni's Hernia is an uncommon case and hence the presentation.

How to cite this article:
Sakalkale R P, Sankhe M, Nagral S, Patel C V. Obstructed Morgagni's hernia (a case report). J Postgrad Med 1991;37:228


How to cite this URL:
Sakalkale R P, Sankhe M, Nagral S, Patel C V. Obstructed Morgagni's hernia (a case report). J Postgrad Med [serial online] 1991 [cited 2021 Feb 26];37:228. Available from: https://www.jpgmonline.com/text.asp?1991/37/4/228/750




  ::   Introduction Top

Morgagni's Hernia is the direct hermation of the intra-abdominal organs through the anterior retrocostoxiphoid diaphragmatic defect[1]. Though it is congenital in origin, many remain asymptomatic for a long time and incidentally discovered on X-ray[6]. Only 3% of the diaphragmatic hernias are of the Morgagni's type[5]. Obstructed Morgagni's hernia is still uncommon and till date only 2 cases have been found in the English literature [1],[6]. Following case report elucidates the case history and hernia morphology alongwith the treatment, in brief.

  ::   Case report Top

ABC, a forty-year-old Hindu male presented to us with colicky abdominal pain, distention of abdomen and bilious vomiting with constipation of three days duration on 30 July 1990. In 1965 he had taken full anti-tubercular treatment for pulmonary lesion. There was no past history of intestinal obstruction. Clinically he was afebrile, pulse 100, BP 140/90, and respiratory rate 24/min. Chest examination showed decrease in air entry at the right base; epigastrium was tender and he had hyperperistalsis. An X-ray chest and abdomen showed (See [Figure - 1]) multiple air fluid levels in the chest on the right side and dilated bowel loops in abdomen. A diagnosis of intestinal obstruction due to obstructed diaphragmatic hernia was made and after preliminary resuscitation he was explored through abdomen by a right paramedian incision. The small bowel was moderately dilated. The cecum was pulled up and was found to be dilated. There was a defect (See [Figure - 2]) in the diaphragm on the right side anteriorly 8 x 6 cm in diameter. A sac was present pushing the diaphragm up. The contents of the hernia sac were transverse colon and omentum. Hernia was reduced and the defect was closed with unabsorbable material (ethilon). The patient made an uneventful recovery and is now asymptomatic.

  ::   Discussion Top

Hernia of the Foramen of Morgagni (or the space of Larrey[3]) occurs through the defect between the sternal and costal attachments of the diaphragm therefore being situated anteriorly and usually contains transverse colon. It is more common on the fight side, because pericardial attachment is more extensive on the left and offers more protection against development of a hernia than the linea does on the right[2]. Therefore it lies between the pericardium and the right pleura. Occasionally it may enter the pericardial sac. Morgagni's observations were based on 625 anatomical dissections. Of the total diaphragmatic hernias only 3% were of the Morgagni's type. Mayo Clinic surgeons Corner and Clagett[1] in an extensive review of 1135 cases of diaphragmatic hernias reported only 50 cases of Morgagni's hernias over 34 years and only one of these was obstructed. In 1988 Rakas et al[6] reported obstructed Morgagni's hernia which contained transverse colon and omentum.
Since the hernia remains symptomless for long time, some have advocated conservative approach[3]. However this hernia, like any other, can give rise to obstructive symptoms at any time and hence surgical reduction and repair should be carried out without delay even on incidental detection. Abdominal approach gives a satisfactory exposure[6].

  ::   Acknowledgments Top

We thank the Dean, Seth GS Medical College and King Edward Memorial Hospital, Parel, Mumbai 400 012, for allowing the hospital data to be used for the case report.

  ::   References Top

1. Corner TP, Clagett OT. Surgical treatment of hernia of the formen of Morgagni. J Thorac Cardiovasc Surg 52: 1966; 461-468.  Back to cited text no. 1    
2.Decker GAG, du Plesis DJ. In: “Lee McGregor's Synopsis of Surgical Anatomy” Twelfth Ed. Mumbai: M Varghese Company; 1986, pp 157-158.  Back to cited text no. 2    
3.Harrington SW. Various types of diaphragmatic hernias, treated surgically. Report of 430 cases. Surg Gynecol & Obstet 1948; 86:735-755.  Back to cited text no. 3    
4.Moghissi K. Operation for repair of obstructed substernocostal (Morgagni) hernia. Thorax 1981; 36:392-394.  Back to cited text no. 4    
5.Morgagni GB. In: “Seats and Causes of Diseases” (Translated by B. Alexander), Vol. 3. lir 54, London: A Millar, T Cajell; 1769, pp 205.  Back to cited text no. 5    
6.Rakas FS, Dayma KG, Gabukamble DB. Obstructed Morgagm's hernia. (A case report) Ind J Surg 1988; 50: 144-146.   Back to cited text no. 6    

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