Clinical Presentations and Surgical Features of Morgagni Hernia in Adults: A Retrospective Study

Abstract

Background and aims: Morgagni hernias are rare congenital diaphragmatic defects that can lead to bowel obstruction and incarceration if not repaired. While this disease typically manifests as respiratory distress, frequent respiratory infections, and infant growth failure, it can sometimes be accidentally discovered in adulthood through cross-sectional imaging. We aimed to report our experience managing this entity during 20 years at our referral center.

Methods: A retrospective chart review was performed of adult patients diagnosed with Morgagni diaphragmatic hernia who underwent surgery at Shiraz University of Medical Sciences in two main referral hospitals between 2002 and 2022. Patients' demographic and clinical data, including surgical features and hospitalization, course were extracted and subsequently analyzed.

Results: Seventeen patients, including three men and 14 women, with an age range of 26 to 92 years (average age 61.5 years), were diagnosed with Morgagni diaphragmatic hernia. Three patients had left-sided hernias, and 14 had right-sided hernias. The most common clinical manifestations were shortness of breath and abdominal pain. The most commonly herniated contents were the omentum and colon. All patients underwent laparotomy, and the hernia sac was removed in 11 patients.

Conclusions: Morgagni is a rare congenital diaphragmatic hernia usually diagnosed incidentally. Laparoscopic repair has high success rates and is a viable option for patients with this pathology.

Keywords: Morgagni hernia; adult hernia; congenital diaphragmatic hernia; surgical repair.

FIGURE 1

X‐ray and upper gastrointestinal series scan of an 87‐year‐old female patient. Large fat density is seen in the lower half of right hemithorax in favor of a large diaphragmatic hernia. Contrast study demonstrates the antrum and stomach and distal part of duodenum is displaced to the lower part of chest, in favor of the mentioned hernia.

FIGURE 2

X‐ray and computer tomography scan of a 40‐year‐old female with Morgagni hernia.

FIGURE 3

X‐ray of a 77‐year‐old female with Morgagni hernia.

FIGURE 4

Computed tomography scan of a 41‐year‐old male patient with Morgagni hernia (Coronal cut).

FIGURE 5

Intraoperative image of a 76‐year‐old female patient with a right Morgagni hernia undergoing laparotomy. The omentum (yellow arrows) was extracted from the hernia sac and the chest cavity (white arrows) and subsequently repaired (green arrow); star: stomach; red arrow: liver.