What is the treatment for a Morgagni hernia presenting with symptoms on the chest?

Symptoms of Morgagni Hernia on Chest

Morgagni hernias present with both gastrointestinal and respiratory symptoms in symptomatic adults, though they have a lower incidence of bowel incarceration or strangulation compared to other diaphragmatic hernias. 1

Clinical Presentation

Common Symptoms

Respiratory symptoms:

• Dyspnea is the most prominent symptom, occurring in the majority of symptomatic patients 2
• Chest pain (pressure-like quality, often right-sided, worsened by lying flat and relieved by standing) 3
• Shortness of breath 4

Gastrointestinal symptoms:

• Abdominal pain 4
• Vomiting 4
• Abdominal fullness 5
• Retrosternal pain 5

Key Clinical Features

Morgagni hernias occur through an anterior diaphragmatic defect and have distinct characteristics:

• 90% are right-sided 2
• 70% occur in females 2
• 92% have hernia sacs 2
• Most commonly contain omentum and transverse colon 2
• Can involve the left lobe of the liver 4

Diagnostic Approach

Start with chest X-ray (both anteroposterior and lateral views) as the first diagnostic study in patients without trauma history presenting with respiratory symptoms. 1, 6

Imaging Findings

Chest X-ray findings (though sensitivity is limited at 2-60%): 1

• Air-containing viscus in the chest 3
• Abnormal bowel gas pattern 1
• Air-fluid level 1
• Wide mediastinum 4
• Suspected loop of bowel on the right side of chest 3

CT scan is the gold standard for diagnosis with sensitivity of 14-82% and specificity of 87% 1. CT findings include:

• Diaphragmatic defect (typically 7 cm or larger) 3
• Intra-abdominal fat and bowel loops within the hernial sac 3
• Herniation of left liver lobe and transverse colon 4

Critical Pitfall

Normal chest X-rays do NOT exclude diaphragmatic hernias, with false negatives occurring in 11-62% of cases. 6 If clinical suspicion persists, proceed directly to CT scan 1.

Treatment Approach

Surgical repair is recommended for ALL cases of Morgagni hernia—both symptomatic and asymptomatic—to avoid future complications including volvulus, small bowel obstruction, incarceration, or strangulation. 3, 4

Surgical Options

Laparoscopic approach is preferred for stable patients 1, 2:

• Offers well-known advantages of minimally invasive surgery 2
• Successfully performed in multiple case series 2, 5
• Can include hernia sac removal and mesh repair 2

Repair techniques include:

• Primary suture closure (for smaller defects) 2
• Primary closure supported with mesh 2
• Mesh-only repair for larger defects 2

Emergency Considerations

Immediate surgical intervention is indicated when:

• Bowel strangulation is suspected 1
• Signs of peritonitis or hemodynamic instability are present 6
• Gastrointestinal obstruction develops 5

Delayed diagnosis increases mortality risk, particularly when treatment is delayed more than 24 hours after symptom onset 1. Undetected hernias can cause bowel strangulation, perforation, severe peritonitis, sepsis, and multi-organ failure 1.

Postoperative Outcomes

Patients typically experience complete resolution of preoperative symptoms following surgical repair 3, 4. Mean postoperative hospital stay is approximately 9-10 days 2, with low recurrence rates when appropriate repair techniques are used 2.