Rapid evolution of a Morgagni hernia with herniation of the left hepatic lobe: case report and review of the literature

Abstract

Morgagni hernias are a rare form of congenital diaphragmatic hernia, commonly found on cross-sectional imaging. Repair is generally performed electively for pulmonary or gastrointestinal symptoms. Our case presented acutely with gastric obstruction. Two months prior she had a small bowel obstruction and underwent computed tomography, diagnostic laparoscopy, lysis of adhesions and takedown of the falciform ligament, where a ‘groove’ to the left of the falciform was noted, but not repaired. We collected the presentation, technique, complications and results of 12 prior cases. A trans-abdominal, robotic-assisted tissue repair of the diaphragm with mesh reinforcement utilizing as few as three ports appears to be safe and effective. The robotic platform offers additional degrees of freedom, making retrosternal operating more ergonomic to the surgeon. The rapid progression of our patient suggests that repair at the time of discovery should be considered so that the serious complications can be avoided.

Robotic Repair of Morgagni Hernia in Adult Patient

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Morgagni hernia is a retrosternal defect between the sternum and the costal attachments of the diaphragm, first described in 1769 (1,2) . The defect is congenital and occurs in childhood but is not diagnosed until later in life when pulmonary, gastrointestinal, or nonspecific thoracoabdominal symptoms such as pressure or pain occur (1) . Pulmonary symptoms may include shortness of breath or recurrent pneumonia.

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“…Pulmonary symptoms may include shortness of breath or recurrent pneumonia. Gastrointestinal symptoms include gastroesophageal reflux, dysphagia, regurgitation, or obstruction (1)(2)(3) . These symptoms usually lead to diagnostic workup, including cross-sectional imaging, leading to elective repair.…”

“…The rarity of the diagnosis makes it difficult to standardize recommendations for the method of repair. Recently, this rare condition has been treated with a robotic-assisted procedure (1)(2)(3)(4)(5)(6) . This video demonstrates a robotic repair of a Morgagni hernia in an adult.…”