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Hepatic heria in adult without history of trauma or surgery is rare, and is sometimes operated under the diagnosis of lung or diaphragmatic tumor. Here, we report a case of hepatic hernia which had been preoperatively suspected of pleural tumor and surgically treated. At surgery, multiple lesions mimicking ectopic endometriosis were found on the diaphragma and hepatic profrusion was found from one of lesions.

A 81-year-old man was referred to our department for the acute onset of dyspnea. Chest radiograph suggested a bowel shadow containing gases in the right chest. Computed tomography (CT) scan revealed the dislocation of the liver and the transverse colon in the right pleural cavity. Although the patient had no history of a blunt trauma, he had undergone the right nephrectomy for the renal cancer 3 years before. An emergency operation revealed the right lobe of the liver and the transverse colon profoundly entering into the right pleural cavity. The dislodged organs were gently restored through a dual approach, and the defect of the diaphragm was repaired with a prosthesis. The postoperative course was satisfactory. A diaphragmatic hernia sometimes occurs acutely and often shows life-threatening symptoms. The occurrence of the diaphragmatic hernia associated with previous surgery must be taken into account, when the procedure involved the diaphragm.

A 72-year-old female was transported by ambulance to our department to undergo transthoracic surgery. She had previously undergone transabdominal surgery under a diagnosis of adult Bochdalek hernia, but the restoration was believed to have been incomplete. During the transthoracic procedure, a dorsolateral defect of the diaphragm was detected and reinforcement with a Gore-Tex patch was performed. The patient's postoperative course was uneventful. Adult Bochdalek hernia is rare, but it requires immediate surgical intervention. Although transabdominal surgery is generally considered the first line treatment approach to restore Bochdalek hernia, restoration of the diaphragm is occasionally difficult. On the other hand, a transthoracic approach is thought to be effective as it allows for observation of the lung and diaphragm, and easy closure of the diaphragmatic defect. As complete restoration through early surgical intervention is important, a transthoracic approach in conjunction with transabdominal surgery should be considered whenever necessary.

A 50-year-old man was admitted to our hospital for the evaluation of a blunted left costophrenic angle on chest roentgenograms. Chest non-enhanced computed tomographic (CT) scans demonstrated the omentum as a crescent-shaped, fat-dense, mass-like shadow on the left dorsal thoracic wall, contiguous with the abdominal cavity and floating. Omental vessels were recognized as funicular water densities running in the superior-to-inferior direction. Magnetic resonance imaging disclosed that the omental vessels ran continuously from the abdominal cavity into the thoracic cavity through a defect in the diaphragm. Diaphragmatic hernia was diagnosed, and corrective surgery performed. We reported this case because the CT-based delineation of omental vessels protruding into the thoracic cavity is rare.

We report our recent experience with an asymptomatic case of Morgagni hernia composed of hypertrophic adipose tissue in the falciform ligament. The patient was a 47-year-old obese para-II woman. A chest X-ray during a routine health checkup showed an abnormal shadow in the right cardiophrenic angle that was larger than one year previously. Computed tomograms revealed a fat-density mass in the right side of the chest in contact with the anterior chest wall, pericardium and sternum that continued into the abdominal cavity. Magnetic resonance imaging (MRI) showed that the intrathoracic mass lesion was continuous with the subphrenic tissue, and that the hilus of the hernia was 5 x 3 cm in size. A barium gastro-intestinal series revealed no abnormal findings. Surgical repair was achieved through the transabdominal approach. The omentum was found in its normal position. The herniated adipose tissue in the falciform ligament was repositioned on the peritoneal side, and excised. The hilus of the hernia was then closed with knotted sutures. Postoperatively, the abnormal shadow on the X-ray was no longer present, and the postoperative course was uneventful. Histological examination revealed the hernia to consist of mature adipose tissue 5 x 10 x 3 cm in size. This is the first case of Morgagni hernia composed of hypertrophic adipose tissue in the falciform ligament reported in Japan.

A rare case of Morgagni's hernia complicated with esophageal hiatus hernia is reported. A 85-year-old female suffered from swallowing disturbance admitted for evaluation of abnormal finding on chest X-ray film. The diagnosis was confirmed by chest roentgenogram, gastro-intestinal series and CT scan. Satisfactory repair was performed by the transabdominal approach and the postoperative course was excellent without any complication.