Al Alawi S, Barkun AN, Najmeh S. Previously undiagnosed Morgagni hernia with bowel perforation detected during repeat screening colonoscopy: A case report. World J Clin Cases 2024; 12(14): 2389-2395 [PMID: 38765745 DOI: 10.12998/wjcc.v12.i14.2389]
Corresponding Author of This Article
Said Al Alawi, MD, Doctor, Division of Gastroenterology, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada. said.alalawi@mail.mcgill.ca
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 16, 2024; 12(14): 2389-2395 Published online May 16, 2024. doi: 10.12998/wjcc.v12.i14.2389
Previously undiagnosed Morgagni hernia with bowel perforation detected during repeat screening colonoscopy: A case report
Said Al Alawi, Alan N Barkun, Sara Najmeh
Said Al Alawi, Alan N Barkun, Division of Gastroenterology, McGill University, Montreal, QC H4A 3J1, Canada
Sara Najmeh, Division of Thoracic surgery, McGill University, Montreal, QC H4A 3J1, Canada
Author contributions: Al Alawi S and Barkun AN were the patient’s gastroenterologist, contributed to manuscript drafting, and reviewed the literature; Najmeh S was the patient’s thoracic surgeon and contributed to manuscript drafting; all authors issued final approval for the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Said Al Alawi, MD, Doctor, Division of Gastroenterology, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada. said.alalawi@mail.mcgill.ca
Received: January 5, 2024 Revised: February 13, 2024 Accepted: April 3, 2024 Published online: May 16, 2024 Processing time: 121 Days and 6.5 Hours
Abstract
BACKGROUND
Morgagni hernia (MH) is a form of congenital diaphragmatic hernia (CDH) characterized by an incomplete formation of diaphragm, resulting in the protrusion of abdominal organs into the thoracic cavity. The estimated incidence of CDH is between 1 in 2000 and 1 in 5000 live births, although the true incidence is unknown. MH typically presents in childhood and can be diagnosed either prenatally or postnatally. However, it can also be asymptomatic and carry the risk of developing into a life-threatening condition in adulthood.
CASE SUMMARY
A 76-year-old female with no history of prior abdominal surgeries presented for an elective colonoscopy for polyp surveillance. During the procedure, when approaching the hepatic flexure, the scope could not be advanced further despite multiple attempts. The patient experienced mild abdominal discomfort, leading to the abortion of the procedure. While in the recovery area, she developed increasing abdominal pains and hypotension. Urgent abdominal imaging revealed herniation of the proximal transverse colon through a MH into the chest with evidence of perforation. The patient underwent laparoscopic urgent colonic resection and primary hernia repair and was discharged uneventfully 2 d later.
CONCLUSION
A MH is a rare condition in adults that can present as a life-threatening complication of colonoscopy, even in patients with a history of uneventful colonoscopies. This case highlights the importance of considering congenital and internal hernias when faced with sudden and unexplained difficulties during colonoscopy. If there is a suspicion of MH, the endoscopist should halt the procedure and immediately obtain abdominal imaging to confirm the diagnosis.
Core Tip: A Morgagni hernia (MH), a congenital gap in the diaphragm, may only become evident later in life. Initially small, this defect enlarges over time due to increased intra-abdominal pressure. Although it usually remains asymptomatic, a MH can lead to severe gastrointestinal or pulmonary complications. We describe the case of a previously asymptomatic 76-year-old woman who underwent a routine follow-up colonoscopy. Unexpectedly, the procedure led to a colonic perforation due to a previously undiagnosed large MH. This rare complication emphasizes the need for endoscopists to be vigilant in suspecting and diagnosing potential intra-procedural complications associated with this condition.
