A Case of Bilateral Morgagni's Hernia Diagnosed Preoperatively Through CT Colonography

Masayasu Kawasaki, Hajime Abe, Kazunori Fujino, Kazuyoshi Hanasawa and Tohru Tani

Division of General Surgery, Shiga University of Medical Science

We report a very rare case of bilateral Morgagni's hernia preoperatively diagnosed in CT colonography. A 60-year-old woman with dyspnea was found. Chest X-ray to have a tumor shadow with intestinal gas in only the right lower lung field, so we first suspected right diaphragmatic hernia containing the transverse colon. The coronal plane of CT colonography, however, clearly showed the tract of the transverse unnaturally ascending and incarcerated in each bilateral thoracic cavity. Following this, we confirmed bilateral diaphragmatic hernia. We operated abdominally, finding that the transverse colon was incarcerated in the bilateral foramen of Morgagni as preoperatively diagnosed. After reducing the colon, we resected hernia sacs, closed the orifices by direct sutures of the diaphragm, and patched them using mesh sheet. In Morgagni's hernia, the omentum or colon usually herniates to the right thoracic cavity. Bilateral occurrence has been reported in 3.9% of cases. Selecting an appropriate surgical approach requires precise preoperative assessment. We found CT colonography to be easy and effective in diagnosing Morgagni's hernia involving the colon.

Key words
diaphragmatic hernia, bilateral Morgagni's hernia, CT colonography

Reprint requests
Masayasu Kawasaki Division of General Surgery, Shiga University of Medical Science
Seta Tsukinowacho, Otsu, 520-2192 JAPAN

Accepted
January 26, 2005

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