The use of the transabdominal approach to repair Morgagni hernia in a 28-year-old symptomatic female: a case report

Morgagni’s hernia is a congenital diaphragmatic hernia, which represents only 3 % of all diaphragmatic hernias. Herein, we report a case of a 28-years old symptomatic female with Morgagni’s hernia who underwent a trans-abdominal surgery using a mesh placed.

P078 SURGICAL PLANNING WITH 3D TECHNOLOGY UN PATIENT WITH MORGAGNI HERNIA AND INGUINAL HERNIA

Aim The use of 3D technology is increasingly used for surgical planning in cases of complex surgery. In the case of the abdominal wall, its use is not very widespread. In this video we present the case of a patient with inguinal hernia and Morgagni hernia in which 3D planning provided us with multiple benefits Material and Methods 71-year-old patient awaiting intervention for right inguinal hernia, presenting progressive dyspnea, abdominal pain and vomiting. A thoraco-abdominal CT scan was performed, which reported a Morgagni hernia containing the transverse colon and omentum. Due to 3D planning, we were able to obtain the abdominal and hernial sac volumes, evaluate the hernial orifice and its relationship with the adjacent structures. Results Laparoscopic repair of the Morgagni hernia was performed by reducing the hernial content, placement of visceral contact mesh fixed with resorbable tackers. In the same surgical act, an inguinal hernioplasty was performed via TAPP. The postoperative period was correct, without complications, and the patient was discharged after 3 days. Two years after the intervention, the patient remains asymptomatic. Conclusions The use of 3D technology for surgical planning facilitates the repair of complex hernias, helping us to assess the surgical indication, hernial volumes and hernial content. Good surgical planning facilitates the performance of the intervention through minimally invasive surgery, in this case two hernias were repaired in the same surgical procedure and with the same incisions, which facilitated the recovery of the patient.

1130 An Obstructed Morgagni Hernia in Adulthood, Could Regular Cocaine Use Have Exacerbated Symptoms?

Introduction Morgagni hernias are an uncommon form of diaphragmatic hernia, it is rare for them to be diagnosed in adulthood and they are often asymptomatic in this population. Case Report We report a case of a 26-year-old female who used cocaine on a weekly basis who presented to the emergency department with an acutely obstructed right-sided Morgagni’s hernia. She underwent laparotomy which demonstrated transverse colon with ischaemic associated omentum inside the hernia. The hernia was reduced, the ischaemic omentum was excised and the 4x4cm diaphragmatic defect closed with 2-0 ethibond without mesh. Conclusions Following review of the literature, the medical risks of cocaine use are well documented, however they focus on the risks from a pharmacological perspective. Further thought should be given to the effects of inhalant cocaine use and how this may exacerbate herniation from the drastic changes in intrathoracic pressure during inhalation of the substance, this is a new possible risk of cocaine use that is not previously mentioned in the literature and warrants further investigation.

Laparoscopic Repair of Morgagni Hernia Combined with Right Hemicolectomy for Bleeding Ascending Colon Carcinoma Lodged within the Chest: A Case Report and Review of the Literature

Background. Morgagni hernias are rare in adults and may be asymptomatic but, nevertheless, require surgical repair, with laparoscopy offering an excellent option. The colon dislodged into the chest through diaphragmatic hernias may be affected by various disorders, including malignancies. Case Report. A 70-year-old obese male presented with fatigue and shortness of breath. CT scan showed the right colon lodged in the chest through a Morgagni hernia. He was anaemic, and colonoscopy revealed a colon cancer. He underwent combined laparoscopic hernia repair with bioabsorbable mesh and right hemicolectomy. Recovery was uneventful, but the patient died 5 months later from chemotherapy-associated cardiac failure. Literature review revealed eight similar published cases, and including ours, there were seven Morgagni hernias, one traumatic hernia, and one Bochdalek hernia. Median age of the five men and four women was 66 (range 49-85) years. Surgical approach was thoracotomy (2), laparotomy (5), and laparoscopy (2). Conclusion. Outcome of the rare condition is determined by the course of the colon cancer. Hernia repair was successful in ours and all other published cases. A combined laparoscopic approach can be safely done.

Strangulated Morgagni hernia masquerading as an acute coronary syndrome

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air–fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although ‘time is the myocardium’ in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.