Stenosing colon neoplasia causing colonic perforation in a patient with morgagni-larrey’s hernia

Congenital diaphragmatic hernia, is a congenital abnormality, rare in adults with a frequency of 0.17-6%. We present the case of an 88-year-old female patient with a history of arterial hypertension, obesity and bronchial asthma. She attended the emergency department of our center with diffuse abdominal pain associated with vomiting, absence of intestinal transit for 4 days and respiratory distress. Laboratory tests showed 11750 leukocytes/µl and PCR 127 mg/L. On suspicion of acute abdomen, a Computerized Tomography (CT) scan was performed (Figure 1), showing a left Morgagni-Larrey Hernia (MH) with gastric chamber and colon inside, with abundant pneumoperitoneum. At surgery we found there was a diffuse purulent peritonitis due to perforation of the transverse colon, which, like the gastric chamber and spleen, was located within a large left diaphragmatic hernia. An extended right hemicolectomy until the tumor in the splenic angle of the colon was surpassed was performed. Congenital diaphragmatic hernia, is a congenital abnormality, rare in adults with a frequency of 0.17-6% [1]. Morgagni hernia was first described in 1769 by the Italian anatomist Giovanni Battista Morgagni as an anterior diaphragmatic hernia. The most common contents of the hernia sac include the omentum, colon, small bowel, stomach, and portions of the liver. MH can occur on each side of the sternum; however, it is more common on the right side. Most cases are asymptomatic. There are no guidelines for surgical treatment, owing to the rarity of cases, however, surgical repair is indicated in all cases to prevent strangulation [2]. We present the case of an 88-year-old female patient with a history of arterial hypertension, obesity and bronchial asthma. She attended the emergency department of our center with diffuse abdominal pain associated with vomiting, absence of intestinal transit for 4 days and respiratory distress. On examination, the patient had a tendency to arterial hypotension, respiratory distress and desaturation requiring oxygen therapy, a distended and tympanic abdomen, painful on diffuse palpation with peritoneal irritation in the upper hemiabdomen.