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文献考察：横隔膜へルニア
【ヘルニアの画像診断】 胸部・横隔膜のヘルニア
Author：金井信恭(聖マリアンナ医科大学 放射線医学), 滝澤謙治, 森田あかね, 八木橋国博, 新美浩, 栗原泰之, 中島康雄
Source：臨床放射線(0009-9252)48巻6号 Page711-717(2003.06)
要旨：横隔膜へルニアとは，横隔膜に生理的に存在する間隙（食道裂孔ヘルニア），あるいは先天異常，外傷によって生じた欠損部を通じて腹腔内臓器が胸腔内に脱出した状態をいう．先天性ヘルニアにはBochdalek孔ヘルニア（胸腹裂孔ヘルニア：先天性ヘルニアの中で最も多い），Morgagni孔ヘルニア（右胸骨後ヘルニア）とLarry孔ヘルニア（左胸骨後ヘルニア：最も少ない）がある（図A）．
Morgagni孔ヘルニアは，胸骨の右後方の裂隙（Morgagni孔）を通じて腹腔臓器が前縦隔に脱出するヘルニアである．約60％が小児例で，ヘルニア内容は可動性の大きい横行結腸か大網の場合が多い．
参考文献
Ann Thorac Surg. 2004 Jun;77(6):1956-9.
Foramen of Morgagni hernia: changes in diagnosis and treatment.
Minneci PC, Deans KJ, Kim P, Mathisen DJ.
BACKGROUND: Foramen of Morgagni hernias are uncommon diaphragmatic hernias for which there are limited reported data. The purpose of this study is to report a recent case series of foramen of Morgagni hernias in the context of new diagnostic and treatment modalities. METHODS: A retrospective chart review was performed over a 15-year period, from 1987 to 2001. Twelve patients who had a foramen of Morgagni hernia repaired at our hospital were identified, and data from these patients were collected. RESULTS: The average age at treatment was 45 years, with 50% of patients being asymptomatic. Radiographic evaluation included computed tomography scans in two thirds of the patients with a 100% sensitivity for diagnosis. All hernias were right-sided, and the most common contents of the hernias were omentum and colon. The transabdominal route was the preferred surgical approach. Thoracoscopy was used in 2 patients to further characterize a mediastinal mass. Two patients underwent laparoscopic repair. Postoperative complications were infrequent, and there were no recurrences during a 6-month to 10-year follow-up. CONCLUSIONS: The emergence of highly accurate diagnostic computed tomography scans combined with less invasive surgical techniques utilizing laparoscopy and thoracoscopy has aided in the treatment of foramen of Morgagni hernias over the last 15 years. PMID: 15172245
追記：ヘルニア嵌頓を起こすと重症となる場合が多く，ヘルニア嚢は巨大化し手術も困難になるので無症状でも手術の適応がある．
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