Symptomatic congenital Morgagni hernia presenting as a chest pain: a case report

Abstract

Background: Morgagni hernia is a rare form of congenital diaphragmatic hernia with a prevalence of 2-3%. It occurs due to a defect on the anterior part of the diaphragm, which allows abdominal organs to penetrate into the thoracic cavity. This condition can be detected during fetal life by routine ultrasonography or late during adult life. Late diagnosis of this condition in adults is extremely rare. According to our literature search, only a few cases of symptomatic hernia in adults have been reported so far. Surgery provides definitive treatment for patients with Morgagni hernia; it is always recommended for symptomatic and asymptomatic adult patients to avoid future complications such as volvulus, small bowel obstruction, incarceration, or strangulation. We report a case of a patient who presented with chest pain due to newly diagnosed congenital diaphragmatic hernia. Case presentation: A 29-year-old unemployed white man with no significant past medical history or family history of coronary artery disease, who was a current smoker with a 1-pack-per-day history, presented to our hospital with a 1-month history of intermittent chest pain. His chest pain was localized to the right side with a pressure-like quality, moderate intensity 4-6/10, nonradiating, and relieved by standing up and worsened by lying flat. His pain was not associated with increase or decrease in activity level. The pain had progressively worsened, which prompted the patient to come to the emergency room. The patient was admitted for further evaluation. A chest x-ray showed a suspected loop of bowel on the right side of the chest. Subsequently, the patient underwent computed tomography of the chest, which revealed a 7-cm defect in the right hemidiaphragm with a large amount of intra-abdominal fat and a loop of the proximal transverse colon within the hernial sac. The patient was evaluated by a surgeon and eventually underwent laparoscopic repair of the diaphragmatic hernia with mesh repair. In follow-up, the patient's symptoms resolved. Conclusion: Morgagni hernia is a rare form of congenital diaphragmatic hernia. It is commonly found either in the first few hours of life or in the antenatal period. It is less common in adults and is usually diagnosed accidentally in asymptomatic patients. Symptomatic adult cases are extremely rare. Respiratory symptoms are the most common presenting symptoms. The primary management for both symptomatic and incidentally discovered asymptomatic cases of Morgagni hernia is surgical correction. Various thoracic and abdominal surgical approaches have been described without a clear consensus on preference for operative repair technique.

Morgagni hernia in adult: A case report

“…Morgagni hernia is the rarest of all CDH, presenting mostly in childhood [4] , [5] . There are some reports documenting its presentation in adulthood [7] , [8] , [9] , [10] . The present case, a 53 years' female was diagnosed as having CDH after developing cardiovascular and respiratory symptoms repeatedly.…”

“…There is no strong recommendation on the cutoff size of the hernia defect to advise use of mesh. Mesh can be considered in cases where there is marked tissue loss of the diaphragm and primary repair is not possible [10] , [18] . Although removal of sac has many advantages like reduction of tissue trauma, low risk of fluid collection and low recurrence, it is advised that the sac not be removed due to the feared complication of massive pneumo-mediastinum [19] , [20] .…”

Doctor, My Chest is Deformed…..

“…[14][15]. Mohamed et al reported an adult with CMH who presented with chest pain due to suspected loop of bowel compressing the right side of the chest [17]. There is also death reported in adult due to cardiac compression and cardiac tamponade secondary to CMH [18].…”

Case Report of a Laparoscopic Primary Diaphragmatic Repair in Acute Penetrating Trauma: Is It Within the Realm of an Acute Care Surgeon?

“…The ability to select the specific type of injury and the exclusion of concomitant injuries allows for an effective acute repair. Anterior diaphragmatic injuries are more amenable to a primary repair and the goal remains a tension free repair [8]. The majority of penetrating trauma injuries are anterior diaphragmatic injuries.…”