LETTERS TO THE EDITOR

 

Morgagni's hernia in elderly age

Hernia de Morgagni de presentación en edad adulta

 

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Key word: Diaphragmatic hernia. Morgagni's hernia. Elderly.

Palabras clave: Hernia diafragmática. Hernia de Morgagni. Adultos.

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Dear Editor,

We present the case of a 65-year-old woman diagnosed years ago of "hiatus hernia". For a few weeks she presents subocclusive crises, because of it, she is studied in our center. In thorax X-ray, intestinal content is estimated in right hemithorax. The herniary default and its content is identified with clarity and accuracy in multiplanar reconstruction thorax -abdomen CT scan (Fig.1), as well as anatomical secondary alterations to process's evolution. We realize supraumbilical laparotomy, great hernia sac being demonstrated containing right colon, hepatic angle and part of transverse colon, also stomach. After reduction of herniary content, primary closing of default is done, without tension, by Vycril Plus's free points (Fig.2).

 

Discussion

Morgagni's hernia, described by first time in 1761, represents 2-5% of diaphragmatic congenital hernias. Its location is paraesternal, more frequent right, because pericardial sac protects the left side (1).

It is frequent that is diagnosed in adult age of an incidental way, since they are in the habit of being asymtomatic. It produces symptoms in situations of increase of abdominal pressure or when they strike new entrails in herniary sac (2). Herniary contents, according to frequency, are epiplum, colon, stomach, liver and small bowel.

With the current imaging technologies, herniary default is delimited perfectly, however herniary contents, so it is possible to plan the intervention (3).

Surgical repair is the only curative treatment indicated in symptomatic adults and asymtomatic young patient, in order it prevents and avoid possible complications. Laparotomy, except exceptions, is the most suitable incision. Generally it is possible a simple primary closing, due to diaphragm laxity, without need to resect the sac. Mesh repair is indicated in wide defaults or tension closings (4).

 

L. Tallón Aguilar, F. Ibáñez Delgado, A. Vázquez-Medina, J. M. Hernández-de-la-Torre and F. Alcántara-Gijón
Unit of Esophageal and Upper Digestive Tract Surgery. Department of General and Gastrointestinal Surgery.
Hospitales Universitarios Virgen del Rocío. Seville, Spain

 

References

1. Torralba Martínez JA, Lirón Ruiz R, Morales Cuenca G, et al. Hernia de Morgagni gigante. Tratamiento laparoscópico mediante prótesis bilaminar (composite) de poliéster. Cir Esp 2002; 72: 303-5.        [ Links ]

2. Echenique M, Amondarain JA, Mar B. Hernias de Morgagni. Presentación de una serie de casos tratados en la era prelaparoscópica. Cir Esp 2002; 71: 197-200.        [ Links ]

3. Pérez Lara FJ, Lobato Bancalero LA, Moreno Ruiz J, et al. Hernia de Morgagni asociada a hernia de hiato. Reparación de la vía laparoscópica. Rev Esp Enferm Dig 2006; 98: 789-90.        [ Links ]

4. Nelly MD. Laparoscopic repair of strangulated Morgagni hernia. World J Emerg Surg 2007; 2: 27.        [ Links ]