In 1769, Morgagni described the diaphragmatic hernia carrying his name, whist doing a post mortem on a head injury patient. Independently, Larrey had described a left-sided Banterior sternoscostal^hernia, and so left-sided Morgagni hernia is also known as a Larrey hernia. It is a very rare type of congenital diaphragmatic hernia with an incidence of 1-3%. It is caused by failure of fusion in the anterior portion of the pleuroperitoneal membrane resulting in retrosternal defect in the diaphragm. Although infants present with recurrent respiratory infections, they can often go unnoticed for several decades. In this case report, we present a 48-year-old male, diagnosed with Larrey hernia who underwent successful total laparoscopic suture repair and Meshplasty. The sac contents were reduced, and the sac was not excised. The edges were approximated, and the mesh was placed to widely cover the defect and suture to the abdominal wall all around. Relevant literature and technical considerations are discussed in this article.

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This 63 year old gentleman, known to suffer from retroviral disease for the past 12 years, first presented in 2011 with carcinoma of caecum, for which he underwent a radical right hemicolectomy. Following this, he presented with descending colon malignancy for which completion colectomy with ileo sigmoid anastomosis was performed (2013). In 2014 he had a right inguinal hernia for which total extraperitoneal hernioplasty was done (TEP) and a mesh tacked with the structures in the posterior wall of inguinal canal. Subsequently in 2016 he developed gastric outlet obstruction secondary to nodal metastasis from his previous malignancy, which was treated with gastrojejunal bypass. He also had a percutaneous transhepatic biliary drainage (PTBD) inserted at that time for obstructive jaundice. After 6 weeks, through the PTBD, an extra long metallic self expanding stent (SEMS) was internalized in the common bile duct (CBD) all the way upto the duodenum (upto D3). Later the PTBD was removed. At this point of time, despite a double colic malignancy with nodal metastasis, with the background of HIV, the patient continues to be stable, anicteric, with no vomiting, but progressively growing weaker due to his malignancy. This x-ray is presented because of the details that can be seen in it:

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