OPEN ACCESS

CASE REPORT

Large Bowel Obstruction Secondary to an Incarcerated

Morgagni Hernia

Javier Chinelli¹, Gustavo Rodríguez²

¹Attending Surgeon

²Chief, Division of Surgery

Corporación Médica de Canelones (COMECA). Canelones, Uruguay

ABSTRACT

To cite:

Morgagni hernia in adults is a rare entity, accounting for approximately 2% of congenital diaphragmatic hernias. It may be

asymptomatic; when clinical manifestations occur, respiratory symptoms are the most common, although acute complications

may also develop. Diagnosis is often incidental, with computed tomography considered the gold standard. Surgical repair is

recommended, preferably via a minimally invasive approach and on an elective basis, both in symptomatic patients and in those

with incidental findings.

We report the case of a male patient presenting with large bowel obstruction secondary to an incarcerated Morgagni hernia. An

exploratory laparotomy was performed, with reduction of the herniated colon and primary repair of the defect. The postoperative

course was uneventful, with no evidence of recurrence at 12 months of follow-up.

Chinelli J, Rodríguez G. Large Bowel

Obstruction Secondary to an incarcerated

Morgagni Hernia. Rev Argent Coloproctol.

2026; 37(2):29-32 doi:10.46768/jz1ctj58

Additional supplemental material is

published online only. To view, please visit

the journal online:

https://doi.org/10.46768/jz1ctj58

Received: November 6, 2025

Accepted: May 12, 2026

Keywords: large bowel obstruction; Morgagni hernia; incarcerated hernia.

this entity as bowel obstruction secondary to colonic

incarceration.

INTRODUCTION

Morgagni hernia is a rare form of congenital

diaphragmatic hernia, with an estimated incidence

of 0.5 per 1,000 live births. It remains asymptomatic

in up to 30% of cases; however, it may occasionally

CASE

A 75-year-old man with ischemic heart disease

presented with a 48-hour history of complete bowel

obstruction associated with abdominal distension

and dyspnea at rest. On physical examination, he

had asymmetric abdominal distension, more

pronounced in the right abdomen, with diffuse

tympany and hyperactive bowel sounds.

Chest radiography demonstrated a heterogeneous

right lower hemithorax opacity (Fig. 1). CT scan

revealed a closed-loop colonic obstruction with a

cecum diameter of 12 cm secondary to a Morgagni

hernia, with incarceration of the transverse colon

(Fig. 2).

present

with

potentially

life-threatening

complications.¹

It results from a congenital diaphragmatic defect

involving the anterior retrosternal portion of the

septum transversum. Morgagni hernia accounts for

approximately 2% of all congenital diaphragmatic

hernias.² The right side is most commonly affected

(up to 90% of cases), corresponding to the variant

originally described by Giovanni Morgagni in 1761.

Bilateral forms account for approximately 8% of

cases, whereas left-sided hernias are exceptional

(approximately 2%), probably because of the

protective effect of the pericardial sac. At present,

computed tomography (CT) is considered the

diagnostic gold standard.

Given the marked abdominal and colonic distension,

a laparotomy was performed. Intraoperatively, the

diagnosis was confirmed, revealing herniation of the

right transverse colon and greater omentum, with no

signs of ischemia or perforation.

The aim of this report is to describe a case whose

distinctive feature was the unusual presentation of

2026 The authors. Published by Revista

Argentina de Coloproctología. This article is

distributed under the Creative Commons

Attribution–NonCommercial–NoDerivatives

4.0 International License (CC BY-NC-ND

4.0)

https://creativecommons.org/licenses/by-

nc-nd/4.0/

Correspondence to

Javier Chinelli

jchinelli01@gmail.com

Figure 1. Frontal chest radiograph showing a heterogeneous paracardiac opacity in the lower right hemithorax (arrow).

REV ARGENT COLOPROCTOL | 2026 | VOL 37, No. 2

CASE REPORT

Figure 2. CT scan. Coronal (A) and sagittal (B) images demonstrate the site of incarceration (arrow). Axial images (C and D) show colonic dilation

with a maximum cecum diameter of 12 cm. Three-dimensional reconstruction (E) depicts the point of incarceration (circle) and the absence of distal

colonic distension (arrow).

The herniated contents were reduced, followed by near-complete

excision of the hernia sac (Fig. 3A, B). The diaphragmatic defect,

measuring approximately 6 cm in diameter, was then repaired

with a running 1-0 polypropylene suture, leaving a portion of the

sac in situ (Fig. 3C).

The postoperative course was uneventful, and the patient was

discharged on postoperative day 3. At 1-year follow-up, chest

imaging demonstrated no evidence of hernia recurrence (Fig. 4).

Figure 3. Intraoperative findings. A. Diaphragmatic defect consistent with a Morgagni hernia. B. Herniated transverse colon with identification

of the site of incarceration (arrow). C. Repair of the defect with a running non-absorbable suture.

DISCUSSION

Morgagni hernia is often incidentally diagnosed on imaging

studies such as chest radiography and/or CT.³ On plain

radiography, a heterogeneous basal opacity or an air–fluid level

may be observed in cases of visceral herniation. The natural

history may involve progressive enlargement of the

diaphragmatic defect with incorporation of additional abdominal

viscera. In decreasing order of frequency, omentum, colon, liver,

and stomach have been described.⁴ Clinical presentation is

variable, ranging from respiratory to abdominal symptoms, with

respiratory manifestations being more common, particularly in

the fifth decade of life.

In symptomatic or complicated cases, CT is the diagnostic

modality of choice, as it allows accurate identification of

herniated contents and assessment of defect size.⁵ Contrast

studies may be considered depending on the patient’s condition

but are generally unnecessary when CT imaging is of adequate

quality.

Surgical treatment is generally recommended due to the risk of

complications, even in asymptomatic patients.⁶ However, this

recommendation remains controversial, particularly in small

Figure 4. One-year postoperative imaging showing no evidence of hernia

recurrence.

defects containing only fat or in elderly patients with significant

LARGE BOWEL OBSTRUCTION SECONDARY TO AN INCARCERATED MORGAGNI HERNIA

Chinelli J, Rodríguez G.

REV ARGENT COLOPROCTOL | 2026 | VOL 37, No. 2

CASE REPORT

Author Contributions

comorbidities, in whom conservative management may be

appropriate. In symptomatic uncomplicated patients, a minimally

invasive abdominal approach (laparoscopic or robotic) is

preferred,⁷ as it is associated with less parietal trauma compared

with open surgery and no significant difference in complication

rates.⁸ In the present case, an open laparotomy was performed due

to the urgent clinical presentation, advanced age, underlying

cardiac disease, and marked colonic distension, all of which

increased the anticipated anesthetic and technical complexity.

The thoracic approach is now rarely used. In contrast, the

abdominal approach is preferred, particularly in the acute setting,

as it allows assessment of bowel viability and exclusion of

complications such as ischemia or perforation.

Repair of the diaphragmatic defect should be individualized

according to clinical context and available resources. Primary

repair without tension may be feasible in small defects, as in the

present case. Mesh reinforcement with non-absorbable prosthetic

material is an alternative for larger defects; however, its use

remains controversial due to reported complications, including

fistula formation involving hollow viscera and technical injury

during fixation, particularly with tackers.⁹ The use of

cyanoacrylate has also been described in selected cases.¹⁰

Composite or coated meshes are additional alternatives.

JC: Conceptualization. Methodology. Research. Data curation. Writing –

original draft. Writing – revision and editing. GR: Supervision. Validation.

Research. Writing – revision and editing. Final approval of the manuscript.

Conflict of interest statement: None.

Funding: None.

Data availability statement: The data are publicly available.

ORCIDS:

Javier Chinelli: 0000-0002-3387-7365

Gustavo Rodríguez: 0000-0003-3465-8364

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CONCLUSIONS

Colonic incarceration within a Morgagni hernia represents an

uncommon cause of bowel obstruction in adults. Computed

tomography is essential for establishing the diagnosis. Surgical

repair is uniformly indicated, particularly in complicated cases,

and the choice of operative approach should be individualized

according to the clinical setting, patient condition, and anticipated

technical challenges.

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LARGE BOWEL OBSTRUCTION SECONDARY TO AN INCARCERATED MORGAGNI HERNIA

Chinelli J, Rodríguez G.