LATE PRESENTATION OF CONGENITAL RIGHT-SIDED MORGAGNI HERNIA IN ELDERLY. A RARE PRESENTATION

Abstract

Morgagni hernia is a rare congenital diaphragmatic defect accounting for a small proportion of diaphragmatic hernias and is infrequently diagnosed in adulthood. Presentation in elderly patients is particularly uncommon, often leading to delayed diagnosis because of nonspecific clinical manifestations. We report the case of a 64 year-old female with a history of type 2 diabetes mellitus, hypertension, and hypothyroidism who presented with abdominal pain, abdominal fullness, early satiety, fatigue, and generalized weakness of one month's duration. Initial chest radiography demonstrated a well-defined opacity in the right cardiophrenic angle. Contrast enhanced computed tomography of the chest revealed a right-sided anterior diaphragmatic defect with herniation of retroperitoneal fat, omentum, and bowel loops into the thoracic cavity, consistent with a Morgagni hernia. Following preoperative evaluation and optimization, the patient underwent elective laparoscopic repair. Intraoperatively, a large diaphragmatic defect measuring approximately 8 × 6 cm containing the transverse colon and greater omentum was identified. The herniated contents were successfully reduced into the abdominal cavity, and the defect was repaired using non-absorbable sutures reinforced with prosthetic mesh. The postoperative course was uneventful, and the patient recovered without complications. This case highlights the importance of considering Morgagni hernia in the differential diagnosis of elderly patients presenting with unexplained gastrointestinal symptoms and right cardiophrenic angle abnormalities on chest imaging. Early diagnosis with computed tomography and timely surgical intervention can prevent serious complications and achieve excellent outcomes. Laparoscopic mesh repair remains a safe and effective treatment option for adult Morgagni hernias.