Restricted accessCase reportFirst published online 2014-6
Nontraumatic Liver Herniation through a Right–Sided Congenital Diaphragmatic Hernia of Morgagni: An Autopsy Case Report with a Review of Liver Herniations through the Defect and a Review of the Defect
Congenital diaphragmatic hernia of Morgagni (CMH) is a rare developmental defect that develops during the development of the human diaphragm. It is usually right-sided and tends to produce symptoms in later life when abdominal viscera herniate into the chest cavities.
Herniations of the liver through this defect into the chest cavities are rare and are often not clinically suspected even when they are associated with symptoms. The amounts of liver tissue involved are usually small, do not cause symptoms and are often an incidental finding during imaging studies of the chest for unrelated symptoms.
This case report documents a clinically unrecognized incidental herniation of the liver into the right chest cavity through a CMH. The report also reviews previously reported cases of liver herniations through a CMH and the possible causes of the defect.
OrringerM.B., KirshM.M., SloanH.Congenital and traumatic diaphragmatic hernias exclusive of the hiatus. Curr Probl Surg.1975 Mar: 1–64.
4.
TorfsC.P., CurryC.J., BatesonT.F., HonoréL.H.A population-based study of congenital diaphragmatic hernia. Teratology.1992 Dec; 46(6): 555–65.
5.
ErenS., ÇirişF.Diaphragmatic hernia: diagnostic approaches with a review of the literature. Eur J Radiol.2005 Jun; 54(3): 448–59.
6.
BrownleeE.M., HowatsonA.G., DavisC.F., SabharwalA.J.The hidden mortality of congenital diaphragmatic hernia: a 20-year review. J Pediatr Surg.2009 Feb; 44(2): 317–20.
7.
HarringtonS.W.Clinical manifestations and surgical treatment of congenital types of diaphragmatic hernias. Rev Gastroenterol.1951 Apr; 18(4): 243–56.
8.
KamathG.S., BorkarS., ChauhanA.A rare case of congenital hernia with ectopic liver and absent pericardium. Ann Thorac Surg.2010 May; 89(5): e36–7.
9.
HedblomC.A.Diaphragmatic hernia. Ann Int Med.1934; 8: 156–76.
10.
SloneT., EmilS., MeissnerN.Sternal cleft, Morgagni hernia, and ectopic liver: a unique chest wall anomaly. J Pediatr Surg.2007 Dec; 42(12): 2132–5.
11.
RashidF., ChaparalaR., AhmedJ., IftikharS.Y.Atypical right diaphragmatic hernia (hernia of Morgagni), spigelian hernia and epigastric hernia in a patient with Williams syndrome: a case report. J Med Case Rep.2009 Jan; 3: 7.
12.
KitanoY., LallyK.P., LallyP.A. Congenital Diaphragmatic Hernia Study Group. Late presenting congenital diaphragmatic hernia. J Pediatr Surg.2005 Dec; 40(12): 1839–43.
13.
ElderE.A., PostlethwaiteJ.M.Note on an abnormality of the liver simulating a thoracic tumour. Lancet.1908 Apr 11; 171(4415): 1073.
14.
PoberB.R.Overview of epidemiology, genetics, birth defects and chromosomal abnormalities associated with CDH. Am J Med Genet C Semin Med Genet.2007 May 15; 145C(2): 158–71.
15.
BradyP.D., SrisupunditK., DevriendtK.Recent developments in the genetic factors underlying congenital diaphragmatic hernia. Fetal Diagn Ther.2011; 29(1): 25–39.
16.
GoumyC., GouasL., MarceauG.Retinoid pathway and congenital diaphragmatic hernia: hypothesis from the analysis of chromosomal abnormalities. Fetal Diagn Ther.2010; 28(3): 129–39.
17.
ClugstonR.D., LattigJ., EnglertC.Teratogen-induced, dietary and genetic models of congenital diaphragmatic hernia share a common mechanism of pathogenesis. Am J Pathol.2006 Nov; 169(5): 1541–9.
18.
GreerJ.J., BabiukR.P., ThébaudB.Etiology of congenital diaphragmatic hernia: The retinoid hypothesis. Pediatr Res.2003 May; 53(5): 726–30.
19.
MajorD., CadenasM., FournierL.Retinol status of newborn infants with congenital diaphragmatic hernia. Pediatr Surg Int.1998; 13: 547–549.
20.
MontedonicoS., NakazawaN., PuriP.Congenital diaphragmatic hernia and retinoids: searching for an etiology. Pediatr Surg Int.2008 Jul; 24(7): 755–61.
21.
MeyJ., BabiukR.P., ClugstonR.Retinal dehydrogenase-2 is inhibited by compounds that induce congenital diaphragmatic hernias in rodents. Am J Pathol.2003 Feb; 162(2): 673–9.
22.
ThébaudB., TibboelD., RambaudC.Vitamin A decreases the incidence and severity of nitrofen-induced congenital diaphragmatic hernia in rats. Am J Physiol.1999 Aug; 277(2 Pt 1): L423–9.
23.
HolderA.M., KlaassensM., TibboelD.Genetic factors in congenital diaphragmatic hernia. Am J Hum Genet.2007 May; 80(5): 825–45.
24.
VeenmaD.C.M., de KleinA., TibboelD.Developmental and genetic aspects of congenital diaphragmatic hernia. Pediatr Pulmonol.2012 Jun; 47(6): 534–45.
25.
WittersI., LegiusE., MoermanP.Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet.2001 Nov 1; 103(4): 278–82.
26.
BielinskaM., JayP.Y., ErlichJ.M.Molecular genetics of congenital diaphragmatic defects. Ann Med.2007; 39(4): 261–74.
ParísF., TarazonV., CasillasM.Hernia of Morgagni. Thorax.1973 Sep; 28(5): 631–6.
30.
IsoY., SawadaT., RokkakuK.A case of symptomatic Morgagni's hernia and a review of Morgagni's hernia in Japan (263 reported cases). Hernia.2006 Dec; 10(6): 521–4.
31.
LiuL., XuY., MaoY.Adult congenital diaphragmatic hernia of the liver: a rare case report. Sci China Life Sci.2010 Feb; 53(2): 204–6.
32.
KhalilA.A.M., McMillanA.M.Morgagni hernia: ten years of idiopathic vomiting. McGill J Med.2009 Jan; 12(1): 25–7.
33.
ThomasV.P.A rare case of hernia of Morgagni presenting in pregnancy. Indian J Surg.2012 Aug; 74(4): 348–50.
HortonJ.D., HofmanL.J., HetzS.P.Clinical presentation and management of Morgagni hernia in adults: A review of 298 cases. Surg Endosc.2008 Jun; 22(6): 1413–20.
BraggW.D., BumpersH., FlynnW.Morgagni hernias: an uncommon cause of chest masses in adults. Am Fam Physician.1996 Nov 1; 54(6): 2021–4.
38.
Rodríguez HermosaJ.I., Tuca RodríguezF., Ruiz FeliuB.Diaphragmatic hernia of Morgagni-Larrey in adults: Analysis of 10 cases. Gastroenterol Hepatol.2003 Nov; 26(9): 535–40.
39.
AppelquistE., Høier-MadsenK.Cribriform diaphragm: a variant of congenital diaphragmatic herniation. A case report. Scand J Thorac Cardiovasc Surg.1986; 20(2): 185–7.
40.
LoonT.P.F., KocherH.M.Clinical presentation and operative repair of hernia of Morgagni. Postgrad Med J.2005 Jan; 81(951): 41–4.
41.
WallisA.G., AroraJ., BishopN.L.Morgagni hernia - A cause of opacification on a chest radiograph. J R Coll Physicians Edinb.2009; 39: 216–7.
42.
Robnett-FillyB., GoldsteinR.B., SampiorD., HomM.Morgagni hernia: a rare form of congenital diaphragmatic hernia. J Ultrasound Med.2003 May; 22(5): 537–9.
43.
YildirimB., OzarasR., TahanV., ArtisT.Diaphragmatic Morgagni hernia in adulthood: correct preoperative diagnosis is possible with newer imaging techniques. Acta Chir Belg.2000 Feb; 100(1): 31–3.
44.
LuoH.F., LeiT., WangH.J., TanG., WangZ.Y.Non-traumatic diaphragmatic hernia of the liver in an adult: a case report. Hepatobiliary Pancreat Dis Int.2007 Apr; 6(2): 219–21.
