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[Intestinal occlusion caused by Morgagni-Larrey diaphragmatic hernia]
G Fornero1, L Rosato, G Coluccio
1Divisione di Chirurgia Generale, Ospedale di Ivrea, Torino.
Abstract:
Morgagni-Larrey's hernias, which are both infrequent and generally asymptomatic, are often diagnosed by chance during routine diagnostic tests performed for other pathologies. Usually congenital in adults, they are often small or only take the form of a pre-hernia lipoma. Intestinal occlusion is rarely described and frequently entails diagnostic difficulties before hydroaerial levels are demonstrated in the thoracic region. In these cases, surgery using an abdominal approach should be preferred in order to treat compressed abdominal viscera at the same time and to exclude the bilateral nature of the lesion. The authors present two cases of an adult man and woman who were referred to their attention for occlusive pathologies. Both were operated using a laparotomy approach. The reduction of abdominal viscera did not present any difficulties. The hernial sac was only removed in the first patient. Plastic surgery was completed by attaching the diaphragmatic flap to the costal and sternal wall using separate non-reabsorbing suture stitches. No complications were reported.
Insights
Morgagni-Larrey hernias are rare congenital diaphragmatic defects, often asymptomatic. Surgical repair via laparotomy is effective for treating associated intestinal obstruction and associated abdominal viscera.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Surgical Anatomy
Background:
- Morgagni-Larrey hernias are infrequent congenital diaphragmatic defects, typically asymptomatic and incidentally discovered.
- They often present as small lipomas or pre-hernias in adults, posing diagnostic challenges when causing intestinal occlusion.
Observation:
- Two adult patients presented with occlusive pathologies secondary to Morgagni-Larrey hernias.
- Both underwent successful surgical intervention using a laparotomy approach for abdominal viscera reduction.
Findings:
- Laparotomy facilitated uncomplicated reduction of abdominal viscera in both cases.
- Surgical repair involved diaphragmatic flap reconstruction, with hernial sac removal in one patient.
- No postoperative complications were reported in either case.
Implications:
- Laparotomy is a preferred surgical approach for Morgagni-Larrey hernias presenting with intestinal obstruction.
- This approach allows simultaneous management of abdominal viscera and assessment for bilateral defects.
- Successful surgical outcomes underscore the efficacy of abdominal repair for these rare hernias.