Case Presentation:
86 year‐old woman presented with nausea, vomiting and upper abdominal pain for 3‐4 days. Pain was crampy in nature, of moderate intensity (6‐7/10 in intensity on a scale of 0‐10) and radiating to mid‐chest at times. Her past medical history is significant for COPD, hypertension, hypothyroidism, cervical and lumbar spinal stenois, psoriasis and small Morgagni’s hernia (congenital diaphragmatic hernia occurring through the sternocostal hiatus of the diaphragm) for years. Her abdominal imaging revealed bowel loops inside the thorax (Panel A, arrows) which was confirmed by Barium study (Panel B, arrows). CT scan of the thorax with oral contrast revealed contrast filled bowel loops in the thorax (Panel C, arrows). The saggital sections of CT scan revealed gastric air (Panel D, arrows) entering the thorax through anterior defect in the diaphragm (Morgagni’s hernia). The patient underwent exploratory laparotomy with reduction of stomach and colon from diaphragmatic hernia defect with repair of diaphragm and gastropexy. Postoperative course was uneventful and patient was discharged home in satisfactory condition.
Discussion:
Morgagni’s hernia is a rare type of congenital diaphragmatic hernia. It occurs by herniation through the foramina of Morgagni, located immediately adjacent to the xiphoid process of the sternum. It usually presents in adulthood. Morgagni’s hernia can be an incidental diagnosis or can present with obstructing symptoms of the herniated viscera. Treatment is surgery with reduction of hernia and diaphragmatic defect repair. Untreated or misdiagnosed hernia of Morgagni can lead to considerable morbidity and occasionally mortality due to the obstructed or strangulated hernial contents.
Conclusions:
It is very important to review past medical history carefully as it can give the clue for current/present problem. Our patient in this case had known history of diaphragmatic hernia for many years.
