A 76-year-old woman with pre-renal azotaemia and Morgagni’s hernia

A 76-year-old woman was evaluated for a 1-month history of diarrhoea and vomiting (10 episodes a day). On admission, serum creatinine was 9 mg/dL. Chest radiography revealed an enlarged right mediastinum containing air (Figure 1). Thoracic computed tomographic (CT) scans showed a Morgagni’s hernia, characterized by an anteromedial diaphragmatic defect (64 × 25 mm), with herniation of the transverse colon and part of the omentum into the thorax (Figure 2) [1]. Morgagni’s hernias are secondary to congenital defects in the anterior diaphragm. The hernia sac frequently contains omentum, but it may contain also the stomach, the bowel or the liver [2]. Symptom severity depends on the extension of abdominal contents into the thorax and the presence of strangulation [3]. Pre-renal azotaemia was treated by total parenteral nutrition, infusion of saline solution (3 L a day) [4] and dopamine 2 μg/kg/min for 2 weeks. On discharge, serum creatinine was 0.9 mg/dL. The patient’s hernia was successfully reduced by laparoscopic technique, and the diaphragmatic defect was repaired with the positioning of a composite mesh [3].