Laparoscopic repair of an Incarcerated Morgagni hernia in the Critically Ill Octogenarian: A case report.

Nidhi Khanna, DO, Jonathan Nguyen, Adeshola Fakulujo, MD, FACS. RowanSOM

Introduction: 

A Morgagni hernia is a rare congenital diaphragmatic hernia which occurs in less than 5 percent of the population. It can be located in the anterior retrosternal or peristernal positions allowing intraabdominal contents to herniate into the chest. Although the majority of Morgagni hernias are discovered in neonates and children, a small percentage are identified later in adulthood. We present a case of an 88 year old male with a gastric outlet obstruction due to an incarcerated Morgagni hernia. Despite his multiple medical co-morbid conditions, which included smoking, COPD on home oxygen, and coronary artery disease, this patient's hernia was repaired successfully using laparoscopy.

Methods:

HT was an 88 year old male who presented with nausea, vomiting, and increasing abdominal pain. CT scan of the abdomen and pelvis demonstrated a large Morgagni hernia causing a gastric outlet obstruction.  Two years prior he had been diagnosed with this hernia and told he would never wean from the ventilator.  Despite several days of conservative management and NGT decompression, the patient failed conservative therapy.  Over the next several days he was medically optimized and finally underwent a laparoscopic repair

Results:

The patient underwent a laparoscopic reduction of the Morgagni hernia, primary closure of the defect using a pledgeted suturing technique, and placement of synthetic mesh using a combination of a tacking device and sutures. The operation was completed in approximately two hours.

Conclusion:

The laparoscopic approach to Morgagni hernia repair is a well documented alternative to the open abdominal or thoracic approach. However, this undertaking has not been described in the octogenarian population. In addition, this patient suffered from multiple medical co-morbidities, making him a high risk surgical candidate. With the advent of new surgical techniques, increased surgeon experience and expertise, these procedures can be performed successfully in a critically ill patient as described in this case report.

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