Perforated Appendicitis Within a Morgagni Hernia: A Laparoscopic Repair

Margaret E. Clark, MD, Benjamin D. Tabak, MD, Andrew T. Schlussel, DO, Jeffery M. Meadows, MD, John D. Andersen, BS, MA, Mary J. Edwards, MD, Stanley M. Zagorski, MD

Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA (Drs. Clark, Tabak, Schlussel, Zagorski, Edwards). Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA (Dr. Meadows). Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA (Dr. Andersen).

ABSTRACT

Laparoscopic repair of a Morgagni hernia is a well-described technique in children or adults who present well beyond the neonatal period. However, it is still most often being repaired by an open approach. This repair can be more challenging when a concomitant infectious process is present, which in this case was a perforated appendicitis. A 22-year-old man presented with typical appendicitis but was found to have a perforated appendicitis contained within a congenital diaphragmatic hernia. We demonstrate the safety and efficacy of using laparoscopy to repair a Morgagni hernia, in the setting of a contaminated field, with primary suture repair. Our patient was able to have both his appendectomy and his Morgagni hernia repair with a single operation, and there was no recurrence of the diaphragmatic defect.

Key Words: Morgagni hernia, Congenital diaphragmatic hernia, Appendicitis in a hernia, Laparoscopic hernia repair.

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