Original Research
Colonoscopy Bowel Preparation Instructions
A pilot study investigated whether the impact of instructions in a group setting improved patient adherence to pre-endoscopy bowel cleaning...
Discussion
A recent review of surgical literature revealed that over a 57-year period, 298 cases of Morgagni hernias have been described in adults. 7 Although previous studies have postulated that a majority of adult patients are asymptomatic, more recent retrospective studies have found about a 70% symptomatic rate of patients with Morgagni hernias. 7 The natural history of adult presentations lends itself to pulmonary (most common) or chronic upper gastrointestinal symptoms, although an acute presentation with potential volvulus and strangulation of the herniated contents has been described. 7
Diagnosis is typically confirmed with a chest X-ray, although the CT scan has become more popular in the era of multimodal imaging. 4,7 Multiple methods of repair have been described; however, thoracotomy has been the most widely used approach, and laparoscopy has gained popularity since the early 1990s. 7 Mesh has been described in more than 60% of cases, and a laparoscopic repair has proven to have a low (< 5%) complication rate and short hospital stay. 8,9 In particular, it has been suggested that a hernia defect larger than 20 to 30 cm 2 should be repaired with a prosthetic adjunct, such as polypropylene, polytetrafluoroethylene, and bovine pericardium with a 1.5- to 2.5-cm mesh overlap. 7,8
Related: Unusual Congenital Pulmonary Anomaly in an Adult Patient With Dyspnea
There is some controversy about the management of the hernia sac, with about 69% of surgeons choosing not to excise the sac due to concerns of intrathoracic or pericardial injury. 7 In a separate study, 36 patients were evaluated retrospectively, and the hernia sac was not resected in any of the patients, with long-term follow-up revealing no evidence of recurrence. 6
Conclusion
To allow for early intervention and avoidance of potentially life-threatening volvulus/strangulation, the medical practitioner has to be aware of this rare diagnosis when performing a workup for vague pulmonary and abdominal symptoms as described here. Disagreement exists over the method of repair and management of the hernia sac as well as the need for mesh buttressing of the defect. A well-planned surgical approach individualized to the patient’s anatomy, surgeon’s expertise, and hernia defect size will provide the best possible outcome with a low operative morbidity.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
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