A Rare Case of Bowel Obstruction Determined by Morgagni Hernia Associated with Giant Paraoesophageal Hernia Treated with Simultaneous Laparoscopic Repair

Abstract

Simultaneous occurrence of Morgagni hernia (MH) and paraoesophageal hernia (PH) is an exceedingly rare condition with only nine cases reported in the English-language literature. Only four cases were treated with laparoscopic approach, and in one case, a robotic procedure was performed. To our knowledge, this is the first case presenting with acute small bowel obstruction, and so requiring an urgent laparoscopic surgical procedure. An 80-year-old male patient presented to our emergency department with acute abdominal pain with nausea, vomiting, and abdominal distention. Antero-posterior chest X-ray and computed tomography which confirmed the presence of mechanical ileus show the cause, represented by extrusion in the right hemithorax of a small bowel loop through a large MH. They also showed a hiatal hernia, with entire stomach and the gastroesophageal junction in a retrocardiac position (type III hiatal hernia). The patient was offered an urgent laparoscopic procedure in order to solve the bowel obstruction. In our case experience, laparoscopic repair has showed to be a feasible option also in urgent conditions.