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Strangulated Morgagni hernia masquerading as an acute coronary syndrome
  1. May Honey Ohn1,
  2. Jun Rong Ng2,
  3. Theviga Neela Mehan3 and
  4. Ng Pey Luen4
  1. 1Cardiology Department, Lewisham Hospital NHS Trust, London, UK
  2. 2Facutly of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  3. 3Emergency Department, Hospital Besar Pulau Pinang, Georgetown, Pulau Pinang, Malaysia
  4. 4Emergency Department, Miri Hospital, Miri, Sarawak, Malaysia
  1. Correspondence to Dr May Honey Ohn; mayhoney.ohn{at}gmail.com

Abstract

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air–fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although ‘time is the myocardium’ in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.

  • gastrointestinal surgery
  • radiology
  • general surgery

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Footnotes

  • Contributors MHO involves in the management of the patient. She wrote the initial draft of the article. JRN and TNM performed the literature search and wrote the final draft of the article and case description. MHO has provided the appropriate guidance to write and publish the article. NPL revised the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.