Giovanni Battista Morgagni
1682-1771
Hernia diafragmatica Morgagni
Giovanni Battista Morgagni
1682-1771
The diafragm is the muscle between the abdomen en thorax. It is an important muscle in the respiratory system. It consists of several parts and between these parts weak components may lead to herniation of abdominal content to the thorax, a diafragmatic hernia. Most common, also in later age, is the hiatal hernia in which an upper displacement of the stomach occurs through a widened passage of the esophagus through the diafragm (B in picture 1). From the congenital hernia's the most common is Bochdalek's hernia (C in picture 1) and this requires immediate operation (2).
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Morgagni's hernia is smaller and can reveal itself in later age (A in picture 1). This was also the case in our patient that was suffering of dyspnea for some time and in whom a former small abnormality in the chest x-ray had become much bigger (3). By means of ct-scan a hernia of Morgagni was diagnosed.
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By laparoscopy the colon and fatty tissue were replaced in the abdomen. The defect is clearly visible as is the lung above the diafragm (4-6).
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The edges of the hernia are rubbed for improved healing after suturing (7-10)
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Then a vicryl
mesh is placed over the sutured tissue to strengthen the area. It is partly
sutured and partly glued (11-14). The glue is used because the heart is very
close to the operating field so stitching is not an option here....
In picture 15 a clear difference can be seen four days after the operation
compared to the preoperative x-ray (3). A little bit woundfluid is still present
above the diafragm where a drain has been in place for a couple of days. The
lung can expand freely again and the patiënt has no more dyspnea.
drawings 1 en 2 from The ciba collection of medical illustrations vol 7, Frank H Netter, MD