title: Right-sided diaphragmatic rupture after repair of a large Morgagni hernia.
abstract: We present a case of a combination of primary and secondary diaphragmatic hernia in a 63-year male patient. For progressive dyspnea and palpitations caused by a large and symptomatic Morgagni hernia resulting in a right-sided enterothorax, an open tension-free mesh repair was performed. The postoperative course was complicated by a secondary hepatothorax through a spontaneous rupture of the right diaphragm. Primary mesh repair of the Morgagni hernia, however, proved to be sufficient. This recurrent herniation might be a consequence of (1) preexisting atrophy of the right diaphragm caused by disposition and/or long-term diaphragmatic dysfunction due to the large hernia, combined with (2) further thinning out of the diaphragm by intraoperative hernia sac resection, and (3) postoperative increase of intra-abdominal pressure.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany, Tobias.Schiergens@med.uni-muenchen.de.
authors.forename: T S
authors.initials: TS
authors.lastname: Schiergens
authors.forename: J G
authors.initials: JG
authors.lastname: Koch
authors.forename: P N
authors.initials: PN
authors.lastname: Khalil
authors.forename: A
authors.initials: A
authors.lastname: Graser
authors.forename: N P
authors.initials: NP
authors.lastname: Zügel
authors.forename: K-W
authors.initials: KW
authors.lastname: Jauch
authors.forename: A
authors.initials: A
authors.lastname: Kleespies