Fig. 48.1
Barium enema showing colonic herniation into a right Morgagni’s hernia (a) and colonic herniation into a left Morgagni’s hernia (b)
Morgagni’s hernia can be bilateral (Fig. 48.2).
Fig. 48.2
Barium enema showing colonic herniation into bilateral Morgagni’s hernia
Morgagni’s hernia is slightly more common in females .
Presentation
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Most Morgagni’s hernias present later in life and are generally asymptomatic discovered accidentally or during the evaluation of other nonrelated conditions.
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Rarely Morgagni’s hernia present in the newborn period with respiratory distress at birth similar to Bochdalek hernia .
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Morgagni’s hernias may also be the cause of recurrent chest infections and nonspecific gastrointestinal symptoms.
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Morgagni’s hernia may also present with cough, dyspnea, and upper abdominal discomfort, fullness, bloating and vomiting.
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Morgagni’s hernia may be discovered as a result of an increase in intra-abdominal pressure secondary to:
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Trauma
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Pregnancy
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Obesity
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Vetriculo-peritoneal shunt
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Associated Anomalies
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Morgagnis’s hernia is well known to be associated with other congenital anomalies. These include :
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Congenital heart disease which is reported in up to 80 % of patients.
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Down’s syndrome (14–35 %). It is well known that children with Down’s syndrome can have other muscular defects such as ventral hernia and diastasis recti. This association as well as that with Morgagni’s hernia suggests a possible muscular deficiency of the ventral paramedian segment of the body in these patients.
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Pentalogy of Cantrell, Noonan syndrome, Prader–Willi syndrome, and Turner syndrome.
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Malrotation in up to 30 % of patients. This must be kept in mind intraoperatively to obviate the risk of postoperative volvulus .
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Diagnosis
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The majority of Morgagni hernias are right sided .
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