Skip to main content

Advertisement

SpringerLink
Log in

Presentation and management of Morgagni hernias in adults: a review of 298 cases

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Morgagni hernias are a very rare form of diaphragmatic hernias. No robust studies have been performed to show the true natural history of this disease process. This study aimed to summarize clinically relevant data with respect to Morgagni hernias in adults. These data should help surgeons workup, diagnose, and treat Morgagni hernias in adult patients.

Methods

A literature search was performed using PubMed, Google scholar, and the following key words: Morgagni, Larrey, retrosternal, retrocostoxiphal, retrochondrosternal, parasternal, substernal, anterior diaphragmatic, and subcostosternal. All case reports and series after 1951 that pertained to adults were included in the review. The following data points were queried: age, sex, presentation, studies used during workup, laterality, surgical approach, hernia sac management, specific laparoscopic techniques, and follow-up evaluation.

Results

These criteria were met by 135 articles representing 298 patients. Based on the data provided, several conclusions regarding this disease process can be drawn. Most patients (72%) present with symptoms related to their hernia. Pulmonary complaints are the most common symptoms (36%). Men present earlier in life than women. Thoracotomy is the most widely used surgical approach (49%). However, laparoscopic repair has gained popularity since its first report in 1992. Laparoscopic surgeons usually repair the defect with mesh (64%) and do not remove the hernia sac (69%). Laparoscopic repair can be performed with a low complication rate (5%) and a short hospital stay (3 days). Outcomes of other surgical approaches also are reported.

Conclusions

Using modern surgical techniques including laparoscopy, repair of Morgagni hernia can be performed safely with a short hospital stay and with little morbidity or mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Harrington SW (1951) Clinical manifestations and surgical treatment of congenital types of diaphragmatic hernia. Rev Gastroenterol 18:243–256

    PubMed  CAS  Google Scholar 

  2. Ackroyd R, Watson DI (2000) Laparoscopic repair of a hernia of Morgagni using a suture technique. J R Coll Surg Edinb 45:400–402

    PubMed  CAS  Google Scholar 

  3. Catalona WJ, Crowder WL, Chretien PB (1972) Occurrence of hernia of Morgagni with filial cervical lung hernia: a hereditary defect of the cervical mesenchyme?. Chest 62:340–342

    Article  PubMed  CAS  Google Scholar 

  4. Lev-Chelouche D, Ravid A, Michowitz M, Klausner JM, Kluger Y (1999) Morgagni hernia: unique presentations in elderly patients. J Clin Gastroenterol 28:81–82

    Article  PubMed  CAS  Google Scholar 

  5. Eglinton T, Coulter GN, Bagshaw P, Cross L (2006) Diaphragmatic hernias complicating pregnancy. ANZ J Surg 76:553–557

    Article  PubMed  Google Scholar 

  6. Akamine S, Kawahara K, Nakamura A et al (1995) Successful utilization of a video-assisted thoracic approach to repair Morgagni’s hernia: report of a case. Surg Today 25:654–656

    Article  PubMed  CAS  Google Scholar 

  7. Hussong RL Jr, Landreneau RJ, Cole FH Jr (1997) Diagnosis and repair of a Morgagni hernia with video-assisted thoracic surgery. Ann Thorac Surg 63:1474–1475

    Article  PubMed  Google Scholar 

  8. Hoffmann KF, Chilko J (1954) Subcostosternal diaphragmatic hernia. Ann Intern Med 41:616–629

    PubMed  CAS  Google Scholar 

  9. Comer TP, Schmalhorst WR, Arbegast NR (1973) Foramen of Morgagni hernia diagnosed by liver scan. Chest 63:1036–1038

    Article  PubMed  CAS  Google Scholar 

  10. Thoman DS, Hui T, Phillips EH (2002) Laparoscopic diaphragmatic hernia repair. Surg Endosc 16:1345–1349

    Article  PubMed  CAS  Google Scholar 

  11. Hajdu NH, Sidhva JN (1955) Parasternal diaphragmatic hernia through the foramen of Morgagni; with report of a case. Br J Radiol 28:355–357

    PubMed  CAS  Google Scholar 

  12. Swain JM, Klaus A, Achem SR, Hinder RA (2001) Congenital diaphragmatic hernia in adults. Semin Laparosc Surg 8:246–255

    Article  PubMed  CAS  Google Scholar 

  13. Comer TP, Clagett OT (1966) Surgical treatment of hernia of the foramen of Morgagni. J Thorac Cardiovasc Surg 52:461–468

    PubMed  CAS  Google Scholar 

  14. Aabye R (1954) Diaphragmatic hernia: right-sided sub-costosternal type in a patient with large gibbus. Acta Chir Scand 108:6–12

    Google Scholar 

  15. Lund RR, Crisler EC, Sammons BP, Gartenlaub C (1958) Simultaneous occurrence of subcostosternal (Morgagni) hernia and hiatus hernia: report of a case. Radiology 70:561–563

    PubMed  CAS  Google Scholar 

  16. Ngaage DL, Young RA, Cowen ME (2001) An unusual combination of diaphragmatic hernias in a patient presenting with the clinical features of restrictive pulmonary disease: report of a case. Surg Today 31:1079–1081

    Article  PubMed  CAS  Google Scholar 

  17. Eroglu A, Kurkcuoglu IC, Karaoglanoglu N, Yilmaz O (2003) Combination of paraesophageal hernia and Morgagni hernia in an old patient. Dis Esophagus 16:151–153

    Article  PubMed  CAS  Google Scholar 

  18. Cokmez A, Durak E (2003) Laparoscopic repair of Morgagni hernia and paraesophageal hernia on the same patient. Surg Endosc 17:660

    PubMed  CAS  Google Scholar 

  19. Chang TH (2004) Laparoscopic treatment of Morgagni-Larrey hernia. West Va Med J 100:14–17

    Google Scholar 

  20. Wickstrom P, Helseth HK (1973) Foramen of Morgagni hernia. Minn Med 56:671–673

    PubMed  CAS  Google Scholar 

  21. Shackelford RT, Hunt EO Jr (1971) Hernia of Morgagni: concurrent presence of peritoneal and pleural sacs through same diaphragmatic defect. South Med J 64:634–636

    PubMed  CAS  Google Scholar 

  22. Dawson RE, Jansing CW (1977) Case report: foramen of Morgagni hernias. J Ky Med Assoc 75:325–327

    PubMed  CAS  Google Scholar 

  23. Tazuke Y, Kawahara H, Soh H et al (2000) Congenital diaphragmatic hernia in identical twins. Pediatr Surg Int 16:512–514

    Article  PubMed  CAS  Google Scholar 

  24. Angrisani L, Lorenzo M, Santoro T, Sodano A, Tesauro B (2000) Hernia of foramen of Morgagni in adult: case report of laparoscopic repair. JSLS 4:177–181

    PubMed  CAS  Google Scholar 

  25. Nguyen T, Eubanks PJ, Nguyen D, Klein SR (1998) The laparoscopic approach for repair of Morgagni hernias. JSLS 2:85–88

    PubMed  CAS  Google Scholar 

  26. Nursal TZ, Atli M, Kaynaroglu V (2000) Morgagni hernia in a patient with Morquio syndrome. Hernia 4:37–39

    Article  Google Scholar 

  27. Moss AJ, Harris DJ (1969) Congenital herniation of the large bowel into the pericardial cavity: survival into adulthood despite a generalized connective tissue disorder. Dis Chest 55:301–305

    Article  PubMed  CAS  Google Scholar 

  28. Chitwood WR Jr, Barnes RL, Postlethwait RW (1976) The retrosternal foramen of Morgagni: massive small bowel herniation. N C Med J 37:658–662

    PubMed  Google Scholar 

  29. Mouroux J, Venissac N, Alifano M, Padovani B (2003) Morgagni hernia and thoracic deformities. Thorac Cardiovasc Surg 51:44–45

    Article  PubMed  CAS  Google Scholar 

  30. Barut I, Tarhan OR, Cerci C, Akdeniz Y, Bulbul M (2005) Intestinal obstruction caused by a strangulated Morgagni hernia in an adult patient. J Thorac Imaging 20:220–222

    Article  PubMed  Google Scholar 

  31. Johnson EK, Mangiardi JL (1952) Subcostosternal diaphragmatic hernia. Am J Surg 84:245–248

    Article  PubMed  CAS  Google Scholar 

  32. Khalid MM (2004) Morgagni’s hernia. J Coll Physicians Surg Pak 14:43–44

    PubMed  Google Scholar 

  33. Bingham JA (1959) Herniation through congenital diaphragmatic defects. Br J Surg 47:1–15

    Article  PubMed  CAS  Google Scholar 

  34. Mullins ME, Stein J, Saini SS, Mueller PR (2001) Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR Am J Roentgenol 177:363–366

    PubMed  CAS  Google Scholar 

  35. Saltzstein HC, Linkner LM, Scheinberg SR (1951) Subcostosternal (Morgagni) diaphragmatic hernia: report of a case of hernia containing stomach, transverse colon, and omentum, with review of the literature. Arch Surg 63:750–765

    CAS  Google Scholar 

  36. de Kort LM, Bax KM (1996) Prosthetic patches used to close congenital diaphragmatic defects behave well: a long-term follow-up study. Eur J Pediatr Surg 6:136–138

    PubMed  Google Scholar 

  37. Polk D, Madden RL, Lipkowitz GS et al (1996) Use of computerized tomography in the evaluation of a CAPD patient with a foramen of Morgagni hernia: a case report. Perit Dial Int 16:318–320

    PubMed  CAS  Google Scholar 

  38. Ramos JM, Burke DA, Veitch PS (1982) Hernia of Morgagni in patients on continuous ambulatory peritoneal dialysis. Lancet 1:161–162

    Article  PubMed  CAS  Google Scholar 

  39. Bhasin DK, Nagi B, Gupta NM, Singh K (1989) Chronic intermittent gastric volvulus within the foramen of Morgagni. Am J Gastroenterol 84:1106–1108

    PubMed  CAS  Google Scholar 

  40. Chin EF, Duchesne ER (1955) The parasternal defect. Thorax 10:214–219

    Article  PubMed  CAS  Google Scholar 

  41. Eren S, Gumus H, Okur A (2003) A rare cause of intestinal obstruction in the adult: Morgagni’s hernia. Hernia 7:97–99

    Article  PubMed  Google Scholar 

  42. Ninos A, Pierrakakis S, Stavrianos V et al (2006) Bilateral congenital anterior diaphragmatic hernia: a case report. Hernia 10:525–527

    Article  PubMed  CAS  Google Scholar 

  43. Slaetis P (1963) Herniation through the foramen of Morgagni: clinical observations in 17 operatively treated cases. Ann Chir Gynaecol Fenniae 52:477–486

    CAS  Google Scholar 

  44. Sirmali M, Turut H, Gezer S et al (2005) Clinical and radiologic evaluation of foramen of Morgagni hernias and the transthoracic approach. World J Surg 29:1520–1524

    Article  PubMed  Google Scholar 

  45. Craighead CC, Strug LH (1958) Diaphragmatic deficiency in the retrocostoxiphoid area. Surgery 44:1062–1069

    PubMed  CAS  Google Scholar 

  46. Wolloch Y, Grunebaum M, Glanz I, Dintsman M (1974) Symptomatic retrosternal (Morgagni) hernia. Am J Surg 127:601–605

    Article  PubMed  CAS  Google Scholar 

  47. Martins M, Kemler RL, Russell JC, Strauch GO (1987) Diaphragmatic hernias of Morgagni. Conn Med 51:282–287

    PubMed  CAS  Google Scholar 

  48. Machtelinckx C, De Man R, De Coster M, Ghillebert G, Provoost V (2001) Acute torsion and necrosis of the greater omentum herniated into a foramen of Morgagni. Abdom Imaging 26:83–85

    Article  PubMed  CAS  Google Scholar 

  49. Sutro WH, King SJ (1987) Computed tomography of Morgagni hernia. N Y State J Med 87:520–521

    PubMed  CAS  Google Scholar 

  50. Bufkin WJ (2001) Chest discomfort and abnormal chest radiograph. Proc Baylor Univ 14:183–184

    CAS  Google Scholar 

  51. Yadav RK, Sukhija S (2001) Morgagni hernia. Indian J Chest Dis Allied Sci 43:163–164

    PubMed  CAS  Google Scholar 

  52. Sarikaya B, Edguer T, Senocak E, Cila A (2006) Multidetector computed tomography findings of an adult patient with Morgagni hernia presenting with perforated appendicitis. Eur J Radiol Extra 58:31–33

    Article  Google Scholar 

  53. Erdem LO, Erdem CZ, Comert M (2004) Intrapancreatic lipoma and Morgagni hernia: a previously unrecognized association. Dig Dis Sci 49:1962–1965

    Article  PubMed  Google Scholar 

  54. Yamashita K, Tsunoda T (2004) Three-dimensional computer images of Morgagni hernia. Am J Surg 187:109–110

    Article  PubMed  Google Scholar 

  55. Collie DA, Turnbull CM, Shaw TR, Price WH (1996) Case report: MRI appearances of left-sided Morgagni hernia containing liver. Br J Radiol 69:278–280

    PubMed  CAS  Google Scholar 

  56. Nishimura RA, Tajik AJ, Schattenberg TT, Seward JB (1985) Diaphragmatic hernia mimicking an atrial mass: a two-dimensional echocardiographic pitfall. J Am Coll Cardiol 5:992–995

    Article  PubMed  CAS  Google Scholar 

  57. Sajeev CG, Francis J, Roy TN, Fassaludeen M, Venugopal K (2003) Morgagni hernia in adult presenting as cardiomegaly. J Assoc Physicians India 51:85–86

    PubMed  CAS  Google Scholar 

  58. Pfannschmidt J, Hoffmann H, Dienemann H (2004) Morgagni hernia in adults: results in 7 patients. Scand J Surg 93:77–81

    PubMed  CAS  Google Scholar 

  59. Rowles DF, Crenshaw GL (1953) Diaphragmatic herniation through the space of Morgagni. California Med 78:461–464

    PubMed  CAS  Google Scholar 

  60. Dalvi AN, Rege SA, Ravikiran CS, Thapar BV, Deshpande AA (2001) Laparoscopic repair of Morgagni hernia in adult. Indian J Gastroenterol 20:70

    PubMed  CAS  Google Scholar 

  61. Meredith K, Allen J, Richardson JD, Bergamini TM (2000) Foramen of Morgagni hernia: surgical consideration. J Ky Med Assoc 98:286–288

    PubMed  CAS  Google Scholar 

  62. White DC, McMahon R, Wright T, Eubanks WS (2002) Laparoscopic repair of a Morgagni hernia presenting with syncope in an 85-year-old woman: case report and update of the literature. J Laparoendosc Adv Surg Tech 12:161–165

    Article  Google Scholar 

  63. Minneci PC, Deans KJ, Kim P, Mathisen DJ (2004) Foramen of Morgagni hernia: changes in diagnosis and treatment. Ann Thorac Surg 77:1956–1959

    Article  PubMed  Google Scholar 

  64. Hunter WR (1959) Herniation through the foramen of Morgagni. Br J Surg 47:22–27

    Article  PubMed  CAS  Google Scholar 

  65. Gilkeson RC, Basile V, Sands MJ, Hsu JT (1997) Chest case of the day: Morgagni’s hernia. AJR Am J Roentgenol 169:266, 268–270

    PubMed  CAS  Google Scholar 

  66. Missen AJ (1973) Foramen of Morgagni hernia. Proc R Soc Med 66:654–656

    PubMed  CAS  Google Scholar 

  67. Rennell CL (1973) Foramen of Morgagni hernia with volvulus of the stomach. Am J Roentgenol Radium Ther Nuclear Med 117:248–250

    CAS  Google Scholar 

  68. Settembre A, Cuccurullo D, Pisaniello D et al (2003) Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report. Hernia 7:52–54

    PubMed  CAS  Google Scholar 

  69. Mannix H Jr, Diethelm AG, Pitman JM Jr (1966) Gastric volvulus within hernia of foramen of Morgagni: cause of intestinal obstruction. NY State J Med 66:521–524

    Google Scholar 

  70. Caprotti R, Mussi C, Scaini A, Angelini C, Romano F (2005) Laparoscopic repair of a Morgagni-Larrey hernia. Int Surg 90:175–178

    PubMed  Google Scholar 

  71. Jemerin EE (1963) Diaphragmatic hernia through the foramen of Morgagni. J Mt Sinai Hosp N Y 30:415–426

    PubMed  CAS  Google Scholar 

  72. Ramachandran CS, Arora V (1999) Laparoscopic transabdominal repair of hernia of Morgagni-Larrey. Surg Laparosc Endosc Percutan Tech 9:358–361

    Article  PubMed  CAS  Google Scholar 

  73. Smith J, Ghani A (1995) Morgagni hernia: incidental repair during laparoscopic cholecystectomy. J Laparoendosc Surg 5:123–125

    PubMed  CAS  Google Scholar 

  74. Huang MW, Young JN (2005) Massive recurrent anterior diaphragmatic hernia, coronary artery disease, and valvular heart disease. Ann Thorac Surg 79:1417–1419

    Article  PubMed  Google Scholar 

  75. Boyd DP, Wooldridge BF (1957) Diaphragmatic hernia through the foramen of Morgagni. Surg Gynecol Obstet 104:727–732

    PubMed  CAS  Google Scholar 

  76. Filipi CJ, Marsh RE, Dickason TJ, Gardner GC (2000) Laparoscopic repair of a Morgagni hernia. Surg Endosc 14:966–967

    PubMed  CAS  Google Scholar 

  77. Kurzel RB, Naunheim KS, Schwartz RA (1988) Repair of symptomatic diaphragmatic hernia during pregnancy. Obstet Gynecol 71:869–871

    PubMed  CAS  Google Scholar 

  78. Loong TP, Kocher HM (2005) Clinical presentation and operative repair of hernia of Morgagni. Postgrad Med J 81:41–44

    Article  PubMed  CAS  Google Scholar 

  79. Contini S, Dalla Valle R, Bonati L, Zinicola R (1999) Laparoscopic repair of a Morgagni hernia: report of a case and review of the literature. J Laparoendosc Adv Surg Tech 9:93–99

    Article  CAS  Google Scholar 

  80. Kuster GG, Kline LE, Garzo G (1992) Diaphragmatic hernia through the foramen of Morgagni: laparoscopic repair case report. J Laparoendosc Surg 2:93–100

    PubMed  CAS  Google Scholar 

  81. Huntington TR (1996) Laparoscopic transabdominal preperitoneal repair of a hernia of Morgagni. J Laparoendosc Surg 6:131–133

    PubMed  CAS  Google Scholar 

  82. Pokorny WJ, McGill CW, Harberg FJ (1984) Morgagni hernias during infancy: presentation and associated anomalies. J Pediatr Surg 19:394–397

    Article  PubMed  CAS  Google Scholar 

  83. Vanclooster P, Lefevre A, Nijs S, de Gheldere C (1997) Laparoscopic repair of a Morgagni hernia. Acta Chir Belg 97:84–85

    PubMed  CAS  Google Scholar 

  84. Greca G, Fisichella P, Greco L et al (2001) A new simple laparoscopic-extracorporeal technique for the repair of a Morgagni diaphragmatic hernia. Surg Endosc 15:99

    PubMed  Google Scholar 

  85. Rau HG, Schardey HM, Lange V (1994) Laparoscopic repair of a Morgagni hernia. Surg Endosc 8:1439–1442

    Article  PubMed  CAS  Google Scholar 

  86. Gray FJ (1981) Strangulated hernia of the foramen of Morgagni: introducing a principle for the reduction of obstructed intraabdominal hernias. Aust N Z J Surg 51:314–317

    Article  PubMed  CAS  Google Scholar 

  87. Rossi G, Weiss M (1967) Herniation and strangulated incarceration of small intestines in the foramen of Morgagni. J Mt Sinai Hosp N Y 34:38–39

    PubMed  CAS  Google Scholar 

  88. Tong RS, Jacobs J, McLaughlin S (2006) Laparoscopic repair of Morgagni diaphragmatic hernia. Surg Pract 10:159–162

    Article  Google Scholar 

  89. Marin-Blazquez AA, Candel MF, Parra PA et al (2004) Morgagni hernia: repair with a mesh using laparoscopic surgery. Hernia 8:70–72

    Article  PubMed  Google Scholar 

  90. Ipek T, Altinli E, Yuceyar S et al (2002) Laparoscopic repair of a Morgagni-Larrey hernia: report of three cases. Surg Today 32:902–905

    Article  PubMed  Google Scholar 

  91. Percivale A, Stella M, Durante V et al (2005) Laparoscopic treatment of Morgagni-Larrey hernia: technical details and report of a series. J Laparoendosc Adv Surg Tech 15:303–307

    Article  Google Scholar 

  92. Yavuz N, Yigitbasi R, Sunamak O et al (2006) Laparoscopic repair of Morgagni hernia. Surg Laparosc Endosc Percutan Tech 16:173–176

    Article  PubMed  Google Scholar 

  93. Bortul M, Calligaris L, Gheller P (1998) Laparoscopic repair of a Morgagni-Larrey hernia. J Laparoendosc Adv Surg Tech 8:309–313

    Article  CAS  Google Scholar 

  94. Richardson WS, Bolton JS (2002) Laparoscopic repair of congenital diaphragmatic hernias. J Laparoendosc Adv Surg Tech 12:277–280

    Article  Google Scholar 

  95. Del Castillo D, Sanchez J, Hernandez M et al (1998) Morgagni’s hernia resolved by laparoscopic surgery. J Laparoendosc Adv Surg Tech 8:105–108

    Google Scholar 

  96. Orita M, Okino M, Yamashita K, Morita N, Esato K (1997) Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni. Surg Endosc 11:668–670

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, Texas, 79920, USA

    John D. Horton, Luke J. Hofmann & Stephen P. Hetz

Authors
  1. John D. Horton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luke J. Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen P. Hetz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John D. Horton.

Additional information

The views expressed in this document are those of the author(s) and do not reflect the official policy of the William Beaumont Army Medical Center, the Department of the Army, the Department of Defense, or the United States Government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horton, J.D., Hofmann, L.J. & Hetz, S.P. Presentation and management of Morgagni hernias in adults: a review of 298 cases. Surg Endosc 22, 1413–1420 (2008). https://doi.org/10.1007/s00464-008-9754-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9754-x

Keywords

Search

Navigation