Morgagni hernia

Case contributed by Dr Domenico Nicoletti

Presentation

Abdominal pain with vomiting.

Patient Data

Age: 45 years
Gender: Male
X-ray

Marked elevation of the right hemidiaphragm with epigastric air-fluid level above the line of gastric fundus. Jejunal loops with air-fluid levels are also visible in the mesogastrium.

CT

CT abdomen with contrast

There is a large dehiscence of the right hemidiaphragm anteriorly, with herniation of the ileum, ascending colon, part of the transverse, omentum, mesentery, gastric body and antrum. There are jejunal air-fluid levels in the mesogastrium with parietal hypertonia due to mechanical obstruction. There is a modest volume of intra-peritoneal free fluid.

Case Discussion

Morgagni hernias are rare diaphragmatic defects. Morgagni hernias in elderly patients are mostly acquired. The weak points in the diaphragm, the parasternal sites bilaterally, are filled with fat, with the upper epigastric artery and vein passing through this space. Diaphragmatic hernias, which become larger with age, start from these weak points under the action of the positive pressure of the abdomen and negative pressure of the thorax.

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Case information

rID: 64158
Published: 7th Nov 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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