A Case of Idiopathic Perforation of the Sigmoid Colon with Morgagni's Hernia

Masahiro Hirose, Yasuo Nanba^*, Yoshihiro Yamamoto^*, Teizou Inoue^* and Yasuhiro Fujiwara^*

Department of Surgery, Nomura Town Hospital

^*Department of Surgery, Kousei General Hospital

We report, herein, on a very rare case of idiopathic perforation of the sigmoid colon with Morgagni's hernia, complicated with MRSA-pneumonia in the late postoperative period. A 88-year-old female was admitted to a local medical clinic because of left abdominal pain with vomiting. The next day she was sent to our hospital with the diagnosis of bowel obstruction. A chest plain X-ray film showed a tumor shadow at the right cardio-diaphragmatic angle and a chest computed tomography showed a bowel shadow in the thoracic cavity. Based on her abdominal findings and the acute abdominal pain, an emergency laparotomy was performed under a diagnosis of diffuse peritonitis due to bowel perforation in the left lower abdomen. There was a perforated lesion (3 cm in size) in the sigmoid colon, and the lesion was repaired by simple suturing. In addition to the bowel perforation, the transverse colon and the greater omentum were found herniated into the thoracic cavity through the right parasternal foramen. The hilus of this foramen was 2×3 cm in size, and it was closed by continuous suturing. From these findings we diagnosed this case as idiopathic perforation of the sigmoid colon with Morgagni's hernia. The patient's early postoperative recovery was uneventful. However, later on the 21th postoperative day, MRSA-pneumonia occurred, but the patient was fortunately able to be discharged on the 39th hospital day. When we treat a high-aged patient, we must consider the possibility of idiopathic perforation of the sigmoid colon and Morgagni's hernia.

Key words
idiopathic perforation of the sigmoid colon, herniation of the foramen of Morgagni, high aged patient

Reprint requests
Masahiro Hirose Department of Surgery, Kousei General Hospital 3-3-28 Minami, Mihara-shi, 723-8686 JAPAN

Accepted
October 26, 1999

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