Dr Kirra Parks MD, MMid, BEd(Distinct), BNurs(Distinct), GradCertACNg(Emerg), Department of Surgery, Wagga Wagga Base Hospital
Dr Jack Peter Archer MD, BPhty (Hons), Department of Surgery, Wagga Wagga Base Hospital
Dr Nicholas Williams MBBS BSc(Med) FRACS, Adjunct Clinical A/Prof University of Notre Dame
Morgagni’s hernia is a congenital diaphragmatic hernia first described by Italian anatomist Battista Morgagni in 1769. It is a rare hernia occurring in only 1-4 per 100,000 births. Caused by the incomplete closure of the pleuroperitoneal folds during fetal development it is usually identified on morphology ultrasound examination during the antenatal period. Only a small percentage are diagnosed in adulthood. There are only 310 cases described in the literature between 1949 and 2020 and there is a paucity of data regarding recommendations for management.
We present a case of a forty-four year old asymptomatic woman who was referred for further investigation of abnormal spirometry results detected on a routine pre-employment medical examination. Medical imaging demonstrated a large defect in the anterior diaphragm with abdominal contents extending to the superior mediastinum. Her case was presented at the Surgical multidisciplinary team meeting and in the context of her lack of symptoms and perceived low risk of incarceration it was decided that non-operative management was most appropriate as perioperative morbidity likely exceeded the risk of future strangulation. The patient passed her pre-employment check and it was recommended that she attend yearly follow-up with her General Practitioner for ongoing surveillance.
While diagnosis of congenital diaphragmatic hernia is rare in adults it remains an important differential diagnosis to consider. There is little evidence regarding the surgical management of Morgagni hernia and very limited evidence describing conservative management options. While it is clear that future research would improve our understanding of the management of this hernia, this case contributes additional knowledge of non-operative treatment to the literature.