Tamesis Steven A, Ayazi Shahin, Komatsu Yoshihiro, Allen Meghan, Jobe Blair A
Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States.
Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States; Department of Surgery, Drexel University, Philadelphia, PA, United States.
Int J Surg Case Rep. 2022 May;94:107164. doi: 10.1016/j.ijscr.2022.107164. Epub 2022 May 4.
Morgagni hernia is an uncommon type of diaphragmatic hernia and commonly presents as a congenital disease. Acquired Morgagni hernias following open cardiac surgery are exceedingly rare and only reported in the pediatric population.
The patient is a 70-year-old female who presented with complaints of shortness of breath and cough one year following a coronary artery bypass graft (CABG). A chest CT scan showed a large Morgagni type diaphragmatic hernia with herniated transverse colon occupying the anterior mediastinum as well as the right hemi-thorax. This hernia was successfully repaired using transabdominal robotic approach with complete resolution of patient's symptoms.
This is the first reported case of acquired Morgagni type diaphragmatic hernia in an adult following open cardiac surgery. The potential etiologies for this hernia include distal extension of the median sternotomy and involvement of the anterior diaphragm, iatrogenic injury to the attenuated anterior diaphragm during pericardial window creation, or pericardial drain placement. Operative repair is the mainstay of treatment and is usually performed with a transabdominal approach since it is thought to be less challenging and allows for evaluation of the entire abdominal cavity. If primary repair cannot be achieved, then synthetic mesh may be needed to obtain a tension free and durable repair.
We present a case of acquired Morgagni type diaphragmatic hernia in an adult following open cardiac surgery that was successfully repaired using a transabdominal robotic approach.
莫尔加尼疝是一种罕见的膈疝类型，通常表现为先天性疾病。心脏直视手术后获得性莫尔加尼疝极为罕见，仅在儿科人群中有报道。
患者为一名70岁女性，在冠状动脉旁路移植术（CABG）后一年出现呼吸急促和咳嗽症状。胸部CT扫描显示一个巨大的莫尔加尼型膈疝，疝入的横结肠占据前纵隔以及右半胸。采用经腹机器人手术方法成功修复了该疝，患者症状完全缓解。
这是首例报道的心脏直视手术后成人获得性莫尔加尼型膈疝病例。该疝的潜在病因包括正中胸骨切开术的远端延伸和前膈的累及、心包开窗术期间对变薄的前膈的医源性损伤或心包引流管放置。手术修复是主要的治疗方法，通常采用经腹途径进行，因为它被认为难度较小，并且可以对整个腹腔进行评估。如果无法进行一期修复，则可能需要使用合成补片来实现无张力且持久的修复。
我们报告了一例心脏直视手术后成人获得性莫尔加尼型膈疝病例，该病例采用经腹机器人手术方法成功修复。
