A CASE OF INCARCERATED ILEUS CAUSED BY LARREY HERNIA

Abstract

Morgagni-Larrey hernias are congenital diaphragmatic hernias, rarely observed and generally identified accidentally due to the lack of symptoms. We experienced a case of incarcerated ileus in an elderly patient caused by Larrey hernia who was successfully treated with an emergency operation. An 85-year-old man was referred to the Emergency Room for left chest pain, and symptom of intestinal obstruction. A simple X-ray photograph and chest CT revealed herniation of the small intestine into the left thoracic cavity. Under the diagnosis of strangulated Larrey hernia, the surgery was performed by the transabdominal approach. We found an anterio-medial defect of the left side diaphragm, through which the ileum and omentum were incarcerated. As a part of the ileum was necrotized, we performed a partial ileotomy, and the hilum of the hernia was closed by a horizontal mattress suture. The patient has been well without any complications after surgery. This case was the oldest ever reported in Japan accorcling to our search of the Internet. Late-stage Morgagni-Larrey hernia is quite rare, but it can cause severe disturbance when complicated. We conclude that an operation should be carried out as soon as this disease is discovered.