Morgagni hernia: Ten years of idiopathic vomiting

INTRODUCTION Morgagni hernia was first described in 1769 by the Italian anatomist Morgagni (1). This hernia is a rare congenital diaphragmatic hernia comprising 2-3% of all diaphragmatic hernias (1, 2). The bowel, stomach, omentum or even the liver can herniate into the chest through a congenital retrosternal defect where the diaphragm joins the costal arch, as first described by Larrey, Napolean's chief surgeon (3). A very small defect is gradually stretched with time, explaining why many cases are silent until adulthood, and presentation may vary from non-specific gastrointestinal symptoms to bowel obstruction and strangulation (2, 4). Gastric outlet obstruction is often the presenting picture when the stomach herniates into the sac (5, 6).In childhood, pneumonia is an important presentation (7, 8).More than half of patients can be diagnosed incidentally while investigating unrelated problems and most symptomatic cases tend to present acutely (9). Despite careful investigations for various presenting symptoms, diagnosis is unsuspected until incidental finding of the hernia on laparotomy or laparoscopy (9). We report a patient who was thoroughly investigated over ten years for repeated vomiting. Repeated chest radiographs, endoscopies, oesophageal manometry and barium follow through revealed no abnormalities. Finally, a CT scan obtained to rule out chronic pancreatitis, showed the hernia and excluded pancreatitis. Subsequently, laparoscopic mesh repair allowed for rapid recovery.