A 55-year-old female of Aryan ethnicity had a history of vague epigastric pain more after taking meals for last 1 year. An ultrasound of the abdomen showed the presence of cholelithiasis. She was planned electively for a laparoscopic cholecystectomy at first. Preoperative workup was done, and no other abnormalities were found except in the chest X-ray, which revealed the presence of a right paracardiac shadow (Figure ). Consequently, she was subjected to CT (computed tomography) scan of the thorax and upper abdomen, which showed the presence of omentum herniating through a retrosternal defect to lie in the right side of the heart in the thorax (Figure ). After complete clinical and imaging evaluations, the patient was considered for a laparoscopic cholecystectomy and laparoscopic repair of the Morgagni hernia (Figure ).\nAnother 44-year-old female of Aryan ethnicity had complaints of retrosternal chest pain and heaviness, who was worked up as a cardiac case in other hospital. On further workup, she was found to have cholelithiasis on ultrasound of the abdomen, and was referred to our hospital for laparoscopic cholecystectomy. A chest X-ray was done, which showed a similar right paracardiac shadow; she was then subjected to a spiral thoraco-abdominal CT scan, which proved the diagnosis of Morgagni hernia (Figure ).\nFor laparoscopic repair, general anesthesia was given, both patients were placed in the supine lithotomy position with their arms at their sides, Foley’s catheter was inserted. A 10-mm trocar port was inserted above the umbilicus via the open technique, and a 0° camera was introduced into the abdominal cavity through this port, and CO2 pneumoperitoneum was created. Operating surgeon was positioned between the legs of the patients, and assistant surgeon at the left side. After primary evaluation in both patients, the Morgagni hernia was located: a segment of omentum from the transverse colon was seen herniating into the hernial sac (Figure ). After insertion of two 5 mm trocar ports on the right and one 5 mm port on left upper abdominal quadrants respectively, patients’ position was changed to a reverse Trendelenburg; there were some adhesions of the omentum to the neck of the sac, and after division of these, the omentum was reduced back into the abdominal cavity. The falciform ligament was divided, and the edge of the defect was approximated with no. 1 polypropylene interrupted sutures (Figure ). Next, the gallbladder was taken care of, after inserting a 10 mm epigastric port, and changing the position of the surgeon to left side of the patient. A polypropylene mesh of size 15 × 15 cm was inserted into the abdominal cavity through the epigastric 10 mm port; it was expanded over the defect and fixed to the anterior abdominal wall and edge of the diaphragmatic defect with a series of two rounds of intracorporeal prolene knots; care being taken not to take deep bites at the diaphragm and avoiding at the left cranial region (the region of the heart) (Figure ). Altogether, for both procedures, total five ports were needed. Patients were admitted to the surgical intensive care unit for the first postoperative day and discharged 72 h after surgery; no postoperative complications were noted; both patients were discharged after proper ambulation and were on soft diets. Postoperative radiograph was satisfactory (Figure ). Follow-up has been done for 12 months postoperatively; there has been no recurrence till date.
An 80-year-old woman came to our hospital with chief compliant of cough, dyspnea at rest, and orthopnea since two weeks before admission. She also had vomiting after heavy meals, generalized vague abdominal pain, dysphagia, regurgitation, epigastric fullness, constipation, and sweating. Clinical exam and diagnostic imaging including CXR and spiral thoracoabdominal CT scan were compatible with Morgagni hernia ().