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August 2, 1971

Costosternal Hernia Through Foramen of Morgagni

JAMA. 1971;217(5):698. doi:10.1001/jama.1971.03190050154024

To the Editor.—  Herniation through the foramen of Morgagni is uncommon, comprising only 2.5% of all diaphragmatic hernias. Harrington1 reported 534 cases of diaphragmatic hernias and encountered only 14 of the costosternal type. This paper illustrates an unusual presentation of a Morgagni hernia as a pyloric obstruction in an elderly man.

Report of a Case.—  An 82-year-old white man was admitted to Oak Forest Hospital for treatment of right hemiparesis. His past history revealed peptic ulcer treated medically in 1940, and a left cerebral thrombosis in 1967 which caused the hemiparesis. While in the hospital for physiotherapy, with improvement of the hemiparesis, he started vomiting food and gastric mucus postprandially. Nasogastric decompression for 48 hours was followed by an x-ray film series of the upper gastro-intestinal tract, which showed a pyloric obstruction and elevation of the right diaphragm (Fig 1). Roentgenograms of the chest revealed elevation of the right