Obstructed right Morgagni hernia with multiple congenital anomalies: a rare presentation

Abstract

Congenital diaphragmatic hernias occur in 1 in 3500 live births. Among the congenital diaphragmatic hernias, morgagni hernias are the rarest accounting for 2-3% of all diaphragmatic hernias. They occur through a congenital defect in the anterior part of the diaphragm just behind the sternum. In most cases the defect in the diaphragm is small and the patient may remain asymptomatic. The occurrence of obstruction or strangulation in these hernias is a rare occurrence. We report a rare case of right sided Morgagni hernia in a 14 years old boy who presented with features of subacute intestinal obstruction. Chest X-ray showed a large right sided diaphragmatic hernia with stomach and bowel loops compressing the right lung. A contrast enhanced computed tomography (CT) scan indicated large right sided diaphragmatic hernia containing gastric volvulus with twisted small bowel loops causing right lung collapse, and congenital anomalies of the right kidney and liver. The patient underwent exploratory laparotomy with an upper midline incision with reduction of hernia and primary repair of the diaphragmatic defect found in the anterior aspect of right diaphragm without placement of a mesh. An ICD was placed in right thoracic cavity to allow the lung to expand. Due to inadequate lung expansion a second ICD was placed in the right third intercostal space on the 9th post-operative day and removed on the 18th post-operative day. Patient was discharged with a single ICD on 20th post-operative day which was removed on first follow up. Patient was asymptomatic and recovered well subsequently.