Morgagni hernia associated with ipsilateral lateral chest wall defect: a case report of transdiaphragmatic intercostal hernia in an adult.

INTRODUCTION AND

IMPORTANCE

Transdiaphragmatic intercostal hernias (TDIHs) are rare and typically posttraumatic. The coexistence of a TDIH with congenital anomalies, such as a Morgagni hernia (MH) and chest wall defect, is exceptionally uncommon. This report details a unique case of MH associated with an ipsilateral intercostal hernia in an adult, underscoring key diagnostic and surgical challenges.

CASE PRESENTATION: A 71-year-old man with multiple comorbidities presented with acute abdominal pain and a right-sided chest wall bulge. Computed tomography revealed a large right lateral diaphragmatic and intercostal hernia between the right 9th and 10th ribs, with bowel loops protruding through the intercostal defect. The symptoms spontaneously improved, and repeat imaging showed a reduction of the hernia content. Thoracotomy revealed an omental herniation through an anteromedial diaphragmatic defect (MH) and a congenital chest wall defect with stretched intercostal muscles. The MH was primarily repaired using nonabsorbable sutures, and rib approximation was performed with absorbable sutures to address the chest wall defect.

CLINICAL DISCUSSION: This case is remarkable for the association of two congenital defects: an MH and a TDIH. Unlike typical posttraumatic TDIHs, the intercostal defect in this case stemmed from congenital chest wall maldevelopment. Preoperative diagnosis was challenging, with the MH initially missed on imaging. This emphasizes the importance of considering congenital variants in atypical hernias.

CONCLUSION

To our knowledge, this is the first documented case of a TDIH occurring in conjunction with an MH, both likely congenital. Prompt recognition and tailored interventions are crucial for avoiding missed diagnoses and complications.