Scientific letter
Bowel obstruction secondary to an incarcerated Morgagni hernia in an adult patient: a rare complication
Oclusión intestinal secundaria a hernia de Morgagni incarcerada en un paciente adulto: una complicación infrecuente
José Antonio Casimiro Pérez
, Natalia Afonso Luis, María Asunción Acosta Mérida, Carlos Fernández Quesada, Joaquín Marchena Gómez
Corresponding author
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Gran Canaria, Spain
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Colon distension in the right hemithorax (arrow). (B) Abdominal CT scan. Incarcerated Morgagni hernia in the transverse colon, leading to symptoms of bowel obstruction (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A Morgagni hernia (MH) is a very rare form of congenital diaphragmatic hernia (2–3% of all diaphragmatic hernias).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This hernia defect is found in the anteromedial portion of the diaphragm, behind the sternocostal insertions. The presence thereof may give rise to the herniation of abdominal viscera (omentum, stomach, colon, liver and small intestine) toward the chest cavity. The hernia defect is usually small and clinically asymptomatic in the majority of patients, often being diagnosed incidentally in adults.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 54-year-old male patient with no significant personal history who attended the Emergency Department with abdominal pain lasting 24<span class="elsevierStyleHsp" style=""></span>h, located in the epigastrium. The onset was sudden, continuous, intense and accompanied by nausea and vomiting, as well as tightness in the chest when lying down. Upon physical examination, the abdomen was found to be distended, tympanitic and painful, with guarding on palpation of the epigastrium.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The chest X-ray revealed colon distension in the right hemithorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Computed tomography (CT) was requested, revealing findings compatible with transverse colon herniation through a diaphragmatic orifice of around 3<span class="elsevierStyleHsp" style=""></span>cm in the anteromedial portion of the right hemidiaphragm (Morgagni hernia). This led to a large-bowel obstruction with a competent ileocecal valve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent emergency laparoscopic surgery and the findings described on the CT scan were confirmed. The incarcerated transverse colon and omentum were then reduced, both of which proved viable and showed no signs of ischemia or perforation. Apposing the edges of the hernia defect was difficult and presented tension, so repair with a low-density condensed polytetrafluoroethylene mesh (Omyra<span class="elsevierStyleSup">®</span> Mesh) was decided upon (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). Oral tolerance was initiated 12<span class="elsevierStyleHsp" style=""></span>h post-surgery, with a positive clinical evolution, and the patient was discharged on the third day without complications.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The incidence of congenital diaphragmatic hernias is very low (1 in 2000 to 1 in 5000 live newborns),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> where MH represents less than 2–3%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The majority of cases relating to MH are diagnosed and repaired in childhood.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> MH has been linked to other congenital abnormalities such as congenital heart diseases, chest wall deformities, intestinal malrotation, omphalocele and chromosomal anomalies (trisomies 13, 18 and 21).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A small number of these hernias (5%) are diagnosed as an incidental finding during chest X-rays on asymptomatic adult patients. Most authors recommend that they be surgically repaired due to the potential risk of incarceration, even in asymptomatic patients.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> However, incarcerated hernias are rare, with very few cases reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In general, surgical correction is recommended, although there are disputes regarding the approach, hernia sac resection and the use of meshes.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thoracotomy and, more frequently, laparotomy, were traditionally the standard surgical approaches. However, after Kuster et al. used laparoscopic surgery to repair a MH for the first time in 1992,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> minimally invasive surgery (including single-port and robot-assisted procedures) has been gaining ground and become the first-choice approach, since it is feasible, fast, safe and enables the patient to recover quickly and be discharged early.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,8–10</span></a> In urgent cases of incarcerated MH or in the presence of comorbidities, laparoscopic surgery is practicable, the patient's clinical and hemodynamic status permitting.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Some authors state that the transthoracic approach provides better exposure and a more optimal view of the phrenic nerve, with a safer hernia sac resection. However, most surgeons prefer to carry out the procedure via the transabdominal route since it is less invasive, as well as being quicker and easier.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Another point to consider is whether or not the hernia sac requires resection. Excision of the sac may result in a reduced recurrence rate, but can also be linked to a greater risk of complications (lesions of the pericardium, pleura, phrenic nerve and bleeding).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Hernia sac resection is not currently deemed necessary in the majority of patients and should only be considered in specific cases.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> As regards the closure of the hernia defect, this differs in children and adults according to the series published on each of them. In the former, most authors consider repair using non-resorbable suture material with interrupted stitches to be the technique of choice, with low recurrence rates (2%).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In adults, the current tendency is to perform a tension-free closure using a mesh, with good results.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A case review of 298 adult MH patients shows thoracotomy to be the most widely used approach (49%), although laparoscopic repair is gaining popularity; the hernia sac is not removed in 69% of cases and a mesh is inserted in 64% of patients.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, we believe that the laparoscopic approach in patients with an incarcerated congenital diaphragmatic hernia offers notable advantages for both the surgeon – due to the excellent exposure of the surgical field – and the patient, with a low complication rate and early hospital discharge.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Casimiro Pérez JA, Afonso Luis N, Acosta Mérida MA, Fernández Quesada C, Marchena Gómez J. Oclusión intestinal secundaria a hernia de Morgagni incarcerada en un paciente adulto: una complicación infrecuente. Gastroenterol Hepatol. 2018;41:444–445.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 2333 "Tamanyo" => 153768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray. Colon distension in the right hemithorax (arrow). (B) Abdominal CT scan. Incarcerated Morgagni hernia in the transverse colon, leading to symptoms of bowel obstruction (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1003 "Ancho" => 2333 "Tamanyo" => 164133 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic surgery. (A) Incarcerated Morgagni hernia (transverse colon and omentum). (B) Hernia defect repair with polytetrafluoroethylene mesh (Omyra<span class="elsevierStyleSup">®</span> Mesh).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical presentation and operative repair of Morgagni hernia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Aghajanzadeh" 1 => "S. Khadem" 2 => "S. Khajeh Jahromi" 3 => "H.E. Gorabi" 4 => "H. Ebrahimi" 5 => "A.A. Maafi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivs203" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2012" "volumen" => "15" "paginaInicial" => "608" "paginaFinal" => "611" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22778140" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Esposito" 1 => "M. Escolino" 2 => "F. Varlet" 3 => "A. Saxena" 4 => "S. Irtan" 5 => "P. Philippe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-006-9086-7" "Revista" => array:3 [ "tituloSerie" => "Surg Endosc" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17285392" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive repair of Morgagni hernia – a multicenter case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Lamas-Pinheiro" 1 => "J. Pereira" 2 => "F. Carvalho" 3 => "P. Horta" 4 => "A. Ochoa" 5 => "M. Knoblich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppnen.2016.03.008" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "273" "paginaFinal" => "278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27142810" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associated malformations in Morgagni hernia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.K. Cigdem" 1 => "A. Onen" 2 => "H. Okur" 3 => "S. Otcu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00383-007-2011-x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Surg Int" "fecha" => "2007" "volumen" => "23" "paginaInicial" => "1101" "paginaFinal" => "1103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17828405" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morgagni-Larrey paraesternal diaphragmatic hernia in the adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Arráez-Aybar" 1 => "C.C. González-Gómez" 2 => "A.J. Torres-García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2009" "volumen" => "101" "paginaInicial" => "357" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19527083" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incarcerated Morgagni Hernia: an unusual cause of large bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Tirumani" 1 => "P. Saddala" 2 => "N. Fasih" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2013.12.004" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2014" "volumen" => "47" "paginaInicial" => "320" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24915742" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diaphragmatic hernia through the foramen of Morgagni: laparoscopic repair case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.G. Kuster" 1 => "L.E. Kline" 2 => "G. Garzo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laparoendosc Surg" "fecha" => "1992" "volumen" => "2" "paginaInicial" => "93" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1534498" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repair of Morgagni hernia in adults with primary closure and mesh placement: first robotic experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Arevalo" 1 => "K. Harris" 2 => "A. Sadiq" 3 => "M.L. Calin" 4 => "B. Nasri" 5 => "K. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Laparoendosc Adv Surg Tech A" "fecha" => "2016" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic mesh repair of adult diaphragmatic hernia: a report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Oguma" 1 => "S. Ozawa" 2 => "A. Kazuno" 3 => "M. Nitta" 4 => "Y. Ninomiya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Asian J Endosc Surg" "fecha" => "2016" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presentation and management of Morgagni hernias in adults: a review of 298 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Horton" 1 => "L.J. Hofmann" 2 => "S.P. Hertz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-008-9754-x" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "1413" "paginaFinal" => "1420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18347869" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004100000007/v2_201810040621/S2444382418301299/v2_201810040621/en/main.assets" "Apartado" => array:4 [ "identificador" => "48446" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004100000007/v2_201810040621/S2444382418301299/v2_201810040621/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382418301299?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 41 | 3 | 44 |
| 2024 September | 41 | 2 | 43 |
| 2024 August | 37 | 1 | 38 |
| 2024 July | 45 | 7 | 52 |
| 2024 June | 28 | 3 | 31 |
| 2024 May | 39 | 3 | 42 |
| 2024 April | 35 | 3 | 38 |
| 2024 March | 54 | 2 | 56 |
| 2024 February | 66 | 4 | 70 |
| 2024 January | 84 | 3 | 87 |
| 2023 December | 47 | 3 | 50 |
| 2023 November | 87 | 4 | 91 |
| 2023 October | 138 | 13 | 151 |
| 2023 September | 61 | 5 | 66 |
| 2023 August | 43 | 5 | 48 |
| 2023 July | 66 | 4 | 70 |
| 2023 June | 83 | 3 | 86 |
| 2023 May | 95 | 3 | 98 |
| 2023 April | 74 | 1 | 75 |
| 2023 March | 83 | 1 | 84 |
| 2023 February | 72 | 5 | 77 |
| 2023 January | 100 | 3 | 103 |
| 2022 December | 56 | 6 | 62 |
| 2022 November | 70 | 10 | 80 |
| 2022 October | 61 | 7 | 68 |
| 2022 September | 54 | 8 | 62 |
| 2022 August | 52 | 7 | 59 |
| 2022 July | 28 | 6 | 34 |
| 2022 June | 27 | 8 | 35 |
| 2022 May | 37 | 5 | 42 |
| 2022 April | 29 | 5 | 34 |
| 2022 March | 47 | 5 | 52 |
| 2022 February | 34 | 11 | 45 |
| 2022 January | 28 | 5 | 33 |
| 2021 December | 27 | 11 | 38 |
| 2021 November | 26 | 8 | 34 |
| 2021 October | 31 | 13 | 44 |
| 2021 September | 20 | 8 | 28 |
| 2021 August | 28 | 8 | 36 |
| 2021 July | 18 | 6 | 24 |
| 2021 June | 16 | 5 | 21 |
| 2021 May | 25 | 5 | 30 |
| 2021 April | 86 | 19 | 105 |
| 2021 March | 28 | 10 | 38 |
| 2021 February | 31 | 5 | 36 |
| 2021 January | 27 | 15 | 42 |
| 2020 December | 21 | 6 | 27 |
| 2020 November | 25 | 12 | 37 |
| 2020 October | 8 | 9 | 17 |
| 2020 September | 43 | 41 | 84 |
| 2020 August | 41 | 28 | 69 |
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