Our patient is a 59 year old lady presented with intermittent pain in the left side of the chest and upper abdomen, difficulty in breathing, and fullness in the chest. After evaluation for cardiac etiology and other possible causes, the patient was admitted.
After admission and initial treatment, basic investigations were done. A routine chest x-ray was suggestive of the presence of bowel loops in the left lower thorax and elevated left side of the dome of the diaphragm. This raised the suspicion of a diaphragmatic hernia, so the patient was subjected to HRCT thorax with CECT abdomen and pelvis. The CT scan confirmed that there was an elevation of the left side of the diaphragm with morgagni's type of diaphragmatic hernia. The transverse colon, omentum, and body of the stomach were seen in the left lower portion of the thorax. The heart was displaced posteriorly and there was a secondary collapse of the lingular segment of the lung.
The patient was posted for a diagnostic laparoscopy with the repair of diaphragmatic hernia. During surgery, the contents of the hernia sac being transverse colon, stomach, and omentum were reduced in the abdominal cavity. The falciform ligament was divided. The defect in the diaphragm was present anterior to the esophagus just behind the sternum suggestive of Morgagni hernia measuring 10 x 6 cm. The hernia defect was closed using intermittent sutures of prolene 1-0. The repaired diaphragm was further reinforced with prolene mesh. The postoperative period of the patient was uneventful, and she was discharged on the third day after surgery.
Consultant General and Laparoscopic Surgeon.
MBBS, MS (General Surgery), FMAS.
Medicover Hospital Sangamner.
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