CONGENITAL LARREY-MORGAGNI HERNIA WITH GASTRIC OUTLET OBSTRUCTION: A RARE ADULT PRESENTATION MANAGED WITH EXTRA PLEURAL DIAPHRAGMATIC MESHPLASTY drshubham12597@gmail.com

 

CONGENITAL LARREY-MORGAGNI HERNIA WITH GASTRIC OUTLET OBSTRUCTION: A RARE ADULT PRESENTATION MANAGED WITH EXTRA PLEURAL DIAPHRAGMATIC MESHPLASTY

2

 

 

 

 

India

Oral or Poster

Larrey-Morgagni hernia is a rare congenital diaphragmatic defect, more commonly diagnosed in pediatric populations. Adult presentation, especially with gastric outlet obstruction, is exceptionally rare. Timely diagnosis and appropriate surgical management are critical to avoid complications.

A 70-year-old female presented with upper abdominal pain, early satiety, and recurrent non-bilious vomiting for two weeks. Chest X-ray and contrast-enhanced CT scan revealed a large anterior diaphragmatic defect (8×6 cm) with herniation of distal stomach, pylorus, transverse colon, and omentum into the anterior mediastinum, causing gastric outlet obstruction. An open upper midline laparotomy was performed. Hernia contents were reduced, the sac excised, and the diaphragmatic defect closed with absorbable sutures reinforced by a polypropylene mesh placed in the extra pleural plane.

The patient had an uneventful recovery. Oral intake resumed by postoperative day 3, with normal bowel function by day 4. She was discharged on postoperative day 6 and remained asymptomatic at one-month follow-up. There was no pleural breach or recurrence, and the extra pleural meshplasty ensured secure, durable repair.

This case underscores the importance of recognizing rare adult presentations of congenital diaphragmatic hernias. Open herniotomy with extra pleural mesh reinforcement offers a safe and effective solution in complex cases involving visceral herniation and gastric obstruction. Timely surgical management in such patients can prevent morbidity and ensure excellent postoperative outcomes.