Presentation
Epigastric pain and vomiting.
Patient Data
Moderate-sized hiatus hernia noted with no definite pneumomediastinum to suggest perforation.
An anterior Morgagni hernia contains a loop of small bowel. Multiple loops of dilated and obstructed small bowel loops in the left side and central abdomen. Subtle pneumatosis and small amount of mesenteric fluid. No free intraperitoneal gas.
The large bowel loops are collapsed although there is fecal loading of the rectum seen.
No lymph node enlargement.
The liver, spleen and the pancreas appear grossly normal for non-contrast examination. The right kidney has multiple cysts. The left kidney is normal.
Impression
Morgagni hernia causing SBO with possible subtle pneumatosis suggesting bowel ischemia with small amount of ascites.
Case Discussion
Laparotomy confirmed a Morgagni hernia through a 4cm anterior diaphragmatic defect containing obstructed small bowel. 90cm of gangrenous small bowel was resected.