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Diaphragmatic hernia. Dear Editor,. Morgagni's hernia is a congenital and infrequent diaphrag- matic defect. It is usually asymptomatic and diagnosed in adults.
1130-0108/2008/100/7/438-445 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2008 ARÁN EDICIONES, S. L.

REV ESP ENFERM DIG (Madrid) Vol. 100, N.° 7, pp. 438-445, 2008

Letters to the Editor

Incarcerated Morgagni’s hernia in an adult Key words: Morgagni’s hernia. Diaphragmatic hernia. Dear Editor,

Morgagni’s hernia is a congenital and infrequent diaphragmatic defect. It is usually asymptomatic and diagnosed in adults. The thoracic or abdominal symptoms are different due to his volume and herniated visceras. It is diagnosed with radiologic studies, essentially with chest radiography. The treatment is surgery by abdominal or thoracic approach. We present a case of an incarcerated Morgagni’s hernia in an elderly woman who needed emergency surgery. We report a case of a 78-year-old woman with personal events of arterial hypertension and Morgagni’s hernia diagnosed incidentally on chest radiography 15 years ago. She was admitted to emergency department with a 2 days history of and intense and diffuse abdominal pain accompanied of vomits and no intestinal rhythm alteration. At physical examination the patient had a soft, depressible abdomen with pain in upper abdomen and less peristalsis. Laboratory examination was normal. The gastroduodenum study showed a great right Morgagni’s hernia with gastric antrum inside, without evidence of contrast in duodenum (Fig. 1). Thoracic-abdominal computed tomography with contrast confirms the presence of a great thoracic hernia with loops of large bowell and gastric antrum inside, and distal portion of antrum-duodenum that seem to be in the hernia collar. We made an emergency surgery that showed a great Morgagni’s hernia with incarcerated gastric antrum, transverse colon and omentum, and a diaphragmatic defect of 11 x 7 cm (Fig. 2). We reduced the herniated visceras into the abdomen, resected the hernial sac and closed the diaphragmatic defect with unresorbable material.

Fig. 1. Great Morgagni’s hernia.

The patient ate at the third day of the postoperative course and went out to the hospital at the fifth day. 18 months before the surgery the patients is asymptomatic. Morgagni-Larrey’s hernia is an anterior or retrosternal, congenital diaphragmatic defect and infrequent. It is more frequent in the right side and in this case is called Morgagni’s hernia, described by Morgagni in 1761. It represent 2% to 3% of the congenit diaphragmatic hernias (1,2).

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LETTERS TO THE EDITOR

REV ESP ENFERM DIG (Madrid)

do this at present on all children when you were able to reach the diagnosis (2,4,5). Treatment options include thoracic or abdominal repair, but the abdominal approach is the most commonly used (1-3). Surgery is the reduction of the hernial content, ensuring its viability, resection or not of the hernial sac and closure of the diaphragmatic defect through simple suture with unresorbable material or use of prosthetic mesh (1,2,5). At present, the laparoscopic approach is used successfully with more frequency (1,4). M. Alvite Canosa, L. Alonso Fernández, M. Seoane Vigo, M. Berdeal Díaz, J. Pérez Grobas, M. Carral Freire, A. Bouzón Alejandro, P. de Llano Monelos and C. Gómez Freijoso

Service of General Surgery A. Complejo Hospitalario Universitario Juan Canalejo. A Coruña, Spain

Fig. 2. Diaphragmatic defect of 11 x 7 cm.

References The majority of hernias of Morgagni are asymptomatic and they are diagnosed in adults (average in the fifth decade of life) (1-3). The content of the hernia is in order of frecuency: omentum, large bowell (generally transverse colon), stomach, liver and small intestine (1,4). It is diagnosed with chest radiography; computed tomography or magnetic resonance imaging helps to a better diagnosis. Barium gastrointestinal study and barium enema are useful for identifiying the contents of the hernia and their impact on the digestive tract (1,5,6). Surgical treatment is required, as hernia repair required only in the symptomatic adult, but on the contrary it is advisable to

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Echenique M, Amondarain A, Mar B. Hernias de Morgagni. Presentación de una serie de casos tratados en la era prelaparoscópica. Cir Esp 2002; 71 (4): 197-200. Loong F, Kocher HM. Clinical presentation and operative repair of hernia of Morgagni. Postgrad Med J 2005; 81: 41-4. Pfannschmidt J, Hoffmann H, Dienemann H. Morgagni hernia in adults: Results in 7 patients. Scand J Surg 2004; 93 (1): 77-81. Barut I, Tarhan OR, Cerci C, Akdeniz Y, Bulbul M. Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient. J Thorac Imaging 2005; 20 (3): 220-2. Carcoforo P, Di Marco L, Schettino AM, Rocca T, Occhionorelli S, Pollinzi V, et al. Intestinal occlusion secondary to Morgagni-Larrey’s herniation in an adult. Case report and analysis of the literature. Ann Ital Chir 1998; 69 (1): 97-100. Colakoglu O, Haciyanli M, Soyturk M, Colakoglu G, Simsek I. Morgagni hernia in an adult: Atypical presentation and diagnostic difficulties. Turk J Gastroenterol 2005; 16 (2): 114-6.

REV ESP ENFERM DIG 2008; 100 (7): 438-445