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LETTERS TO THE EDITOR
Letter to the editor
Comment on: “Non-traumatic right anterior diaphragmatic hernia: an unusual cause of bowel obstruction.
Case report.” Vergara Sanchez J, Garat V, Hoffmann B. Rev Argent Coloproctol. 2025;36(3):25-27.
To the Editor,
To cite:
Pastore, RLO. Comment on: “Non-traumatic
right anterior diaphragmatic hernia: an
unusual cause of bowel obstruction. Case
report.” Vergara Sanchez J, Garat V,
Hoffmann B. Rev Argent Coloproctol. 2025;
37(2):37-38. doi:10.46768/b0rwc234
Vergara Sánchez et al. describes an uncommon case of a Morgagni’s diaphragmatic hernia in a nonagenarian patient
presenting with bowel obstruction. The right-sided location, absence of prior trauma, and the patient's advanced age
make this case particularly noteworthy.
Diaphragmatic hernias are most commonly associated with trauma or congenital anomalies. In contrast, non-
traumatic hernias, especially in older adults, may be related to age-associated weakening and loss of elasticity of the
diaphragm and surrounding connective tissue. Contributing factors include increased intra-abdominal pressure due
to chronic cough, obesity, or constipation, all of which are more prevalent in the elderly. In nonagenarians,
symptoms of a diaphragmatic hernia may be subtle or attributed to other age-related conditions, such as dyspepsia
or respiratory disorders, potentially delaying diagnosis.1–3
u
Additional supplemental material is
published online only. To view, please visit
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Received: October 2, 2025
Accepted: October 4, 2025
In this case, presentation as bowel obstruction prompted CT imaging, which established the diagnosis and enabled
timely surgical management, thereby preventing potential intestinal ischemia that could have complicated the
procedure and worsened the patient's prognosis. Resolution of the obstruction and repair of the diaphragmatic defect
were achieved successfully without complications.
However, the indication for colostomy, performed due to marked cecal distention and advanced sigmoid
diverticulosis, warrants further discussion. Uncomplicated sigmoid diverticulosis alone does not constitute an
indication for fecal diversion.⁴ Furthermore, following reduction of the herniated colon, cecal distension may have
been resolved as the intraluminal contents moved distally through compression maneuvers.
If concern existed regarding cecal wall fragility, a cecostomy could have provided decompression with lower
morbidity and greater ease of subsequent restoration of bowel continuity. In contrast to colostomy, cecostomy often
closes spontaneously after tube removal, whereas restoration of bowel continuity in elderly patients is not always
feasible.
Rita L. O. Pastore, MD, PhD
División Cirugía, Sector Coloproctología, Hospital Juan A. Fernández
Buenos Aires, Argentina
Author Contributions
Conceptualization: RLOP.
Writing – review & editing: RLOP.
report of abdominal mesh repair and diagnostic challenges.
Cureus. 2025;17(5):e83376. doi:10.7759/cureus.83376.
2. Rodriguez Hermosa JI, Tuca Rodrigues F, Ruiz Feliu B,
Girones Vila J, Roig Garcia J, Codina Cazador A, et al.
Diaphragmatic hernia of Morgagni-Larrey in adults: analysis
of 10 cases. Gastroenterol Hepatol. 2003;26:535–40.
doi:10.1016/S0210-5705(03)70408-7.
Conflict of Interest Statement: None.
Funding: None.
Data Availability Statement: The data are publicly available.
3. Iso Y, Sawada T, Rokkaku K, Furihata T, Shimoda M, Kita J,
et al. A case of symptomatic Morgagni's hernia and a review
of Morgagni's hernia in Japan (263 reported cases). Hernia.
2006;10:521–4. doi:10.1007/s10029-006-0123-1.
ORCID
Rita L. O. Pastore 0000-0001-5240-9068
4. Hall J, Hardiman K, Lee S, Lightner A, Stocchi L, Paquette
IM, et al. The American Society of Colon and Rectal
Surgeons clinical practice guidelines for the treatment of left-
sided colonic diverticulitis. Dis Colon Rectum. 2020;63:728–
47.
© 2026 Los autores. Publicado por Revista
Argentina de Coloproctología. Este artículo
se distribuye bajo licencia Creative
Commons Atribución–NoComercial–
SinDerivadas 4.0 Internacional (CC BY-NC-
ND 4.0).
REFERENCES
1. Prakash P, Krishnan K, Chandran M, Sundar M. Spontaneous
acquired diaphragmatic hernia in an elderly female: a case
Correspondence to
Rita L. O. Pastore