Hernia (2006) 10:521–524 DOI 10.1007/s10029-006-0123-1 123 CASE REPORT A case of symptomatic Morgagni’s hernia and a review of Morgagni’s hernia in Japan (263 reported cases) Y. Iso · T. Sawada · K. Rokkaku · T. Furihata · M. Shimoda · J. Kita · K. Kubota Received: 4 May 2006 / Accepted: 13 July 2006 / Published online: 16 August 2006  Springer-Verlag 2006 Abstract An 81-year-old female patient was admitted to the emergency room of our hospital with complaints of respiratory distress, abdominal ache, nausea, and intermittent vomiting. A plain X-ray of the abdomen and chest revealed air-Xuid levels on the abdomen and the right side of the chest. Laboratory tests showed severe acidemia with a blood base excess level of ¡24.9 mmol/L. Since the patient was considered to have acute intestinal obstruction due to transverse colon herniation into the thorax through a foramen of Morgagni, emergency surgery was performed. Opera- tive Wndings revealed that the retrosternal diaphragm had a defect of 5 cm in diameter and 20 cm in length with the transverse colon herniated into the thorax. The diaphragm defect was sutured Wrst, and partial resection of the transverse colon was performed. After the operation, the patient had no symptoms and no recurrence has been observed during the 1-year follow- up. There have been 263 reported cases of Morgagani hernia in Japan. The case of the Morgagni hernia is reported here with some bibliographical comments. Keywords Morgagni’s hernia · Ileus · Acute abdomen Introduction Congenital diaphragmatic abnormalities occur in 1/ 2,000 to 1/4,000 membranes [1, 2]. The most common defect is congenital diaphragmatic hernia, and 90% of these hernias are Bochdalek’s type. Morgagni’s hernias are less common. Although Morgagni’s hernias are generally asymptomatic and frequently found coinci- dentally during routine diagnostic tests for other pathologies, rarely they may be symptomatic due to intestinal obstruction or respiratory distress. We pres- ent an adult Morgagni’s hernia case with acute abdomi- nal symptoms secondary to transverse colon herniation and intestinal obstruction as a consequence. Case report: clinical course An 81-year-old female patient was admitted to the emergency room of our hospital with complaints of respiratory distress, abdominal ache, nausea, and inter- mittent vomiting. On physical examination, abdominal distension and weak bowel movement were observed. She was 35 kg in weight and 140 cm in height. A plain X-ray of the abdomen and chest revealed air-Xuid lev- els on the abdomen and the right side of the chest (Fig. 1). On a computed tomography (CT) of chest and abdomen, intrathoracic transverse colon was demon- strated on the right cardio-diaphragmatic angle. There were also cardiac deviation and atelectasis in adjacent lung parenchyma. Laboratory test showed severe aci- demia with a blood base excess level of ¡24.9 mmol/L (Table 1). Since the patient was considered to have acute intestinal obstruction due to transverse colon herniation into the thorax through a foramen of Mor- gagni, emergency surgery was performed. Operative Wndings revealed that the retrosternal diaphragm had a defect of 5 cm in diameter and 20 cm in length with the transverse colon herniated into the thorax (Fig. 2). The Y. Iso (&) · T. Sawada · K. Rokkaku · T. Furihata · M. Shimoda · J. Kita · K. Kubota Second Department of Surgery, Dokkyo University School of Medicine, 880 Mibu, Tochigi 321-0293, Japan e-mail: cch46590@nyc.odn.ne.jp