Case Report: Incidental Finding and Repair of a Morgagni Diaphragmatic Hernia during a Laparoscopic Cholecystectomy
Key Words: Morgagni Hernia, Case Report, Laparoscopic Cholecystectomy
Abstract
Morgagni hernias are a rare finding, but even rarer are those that present asymptomatically in adulthood. This case presentation discusses an asymptomatic Morgagni hernia that was incidentally found in an elderly patient during a laparoscopic cholecystectomy. Our patient complained of right upper quadrant pain, generalized abdominal pain, fatigue, and frequent headaches one year prior to admission. The preoperative diagnosis of chronic cholecystitis was made with the help of hepatobiliary enzyme analysis and ultrasound. During the procedure, a cephalad …show more content…
The gallbladder was successfully visualized and removed without any complications. No stones were found within the gallbladder. During the procedure, it became evident that a portion of omentum was herniated into the upper abdominal wall just medial to the falciform ligament of the liver. With the laparoscopic grasper, the herniated omenta were able to be reduced. There was no strangulation or incarceration of the omenta observed. A large hernia was visualized on the anterior aspect of the diaphragm, measuring roughly 7 cm wide and 3 cm in the anteroposterior distance. The Morgagni hernia was then repaired with three #2 Ethibond interrupted sutures via vertical mattress. The sutures were brought through the subxiphoid abdominal wall into the peritoneal cavity, passed through the diaphragm, then brought out of the abdominal wall again through the same skin hole. The three sutures were tied and the defect was successfully approximated without tension. The remaining viscera were …show more content…
Controversy stems from whether to use a thoracic or transabdominal approach for exploration. The transabdominal approach, followed by reduction of the contents and suture or mesh closure is often done. Laparoscopic repair is generally considered the best surgical method for repairing Morgagni Hernias but laparotomy is also useful in more complicated
Key Words: Morgagni Hernia, Case Report, Laparoscopic Cholecystectomy
Abstract
Morgagni hernias are a rare finding, but even rarer are those that present asymptomatically in adulthood. This case presentation discusses an asymptomatic Morgagni hernia that was incidentally found in an elderly patient during a laparoscopic cholecystectomy. Our patient complained of right upper quadrant pain, generalized abdominal pain, fatigue, and frequent headaches one year prior to admission. The preoperative diagnosis of chronic cholecystitis was made with the help of hepatobiliary enzyme analysis and ultrasound. During the procedure, a cephalad …show more content…
The gallbladder was successfully visualized and removed without any complications. No stones were found within the gallbladder. During the procedure, it became evident that a portion of omentum was herniated into the upper abdominal wall just medial to the falciform ligament of the liver. With the laparoscopic grasper, the herniated omenta were able to be reduced. There was no strangulation or incarceration of the omenta observed. A large hernia was visualized on the anterior aspect of the diaphragm, measuring roughly 7 cm wide and 3 cm in the anteroposterior distance. The Morgagni hernia was then repaired with three #2 Ethibond interrupted sutures via vertical mattress. The sutures were brought through the subxiphoid abdominal wall into the peritoneal cavity, passed through the diaphragm, then brought out of the abdominal wall again through the same skin hole. The three sutures were tied and the defect was successfully approximated without tension. The remaining viscera were …show more content…
Controversy stems from whether to use a thoracic or transabdominal approach for exploration. The transabdominal approach, followed by reduction of the contents and suture or mesh closure is often done. Laparoscopic repair is generally considered the best surgical method for repairing Morgagni Hernias but laparotomy is also useful in more complicated