Diaphragmatic hernia

Case contribution: Dr Radhiana Hassan


  • A 30 years old lady
  • No knowm medical illness
  • Presented with epigastric pain for one month
  • Became severe with nausea and non-billous vomiting
  • She was pregnant at 30 weeks, Gravida 2
  • Clinically patient was tachypnoeic and in severe pain
  • Other vital signs were stable

Chest radiograph findings:

  • A large lucent lesion seen occupying the left hemithorax (red arrows)
  • It shows thick wall with no fluid levels within
  • Left hemidiaphragm is not well visualized
  • The trachea and mediastinum is shifted to the right side (yellow arrows)

CT scan findings:

  • Herniation of stomach (yellow arrows), bowel loops and mesentery (red arrows) are seen into left hemithorax
  • It occupies almost the whole left thoracic cavity
  • Mediastinal shift to the right side

Intra-operative findings:

  • An emergency laparotomy was performed
  • A gush of air during the initial opening of peritoneum with peritoneum contaminated with bowel content.
  • The distal part of the stomach, the whole large bowel, small bowel and appendix were found inside the hemithorax
  • A 6×4 cm defect at posterolateral aspect of hemidiaphragm
  • The greater curvature of stomach was ischaemic and a 2×3 cm perforation seen

Diagnosis: Adult diaphragmatic hernia


  • Diaphragmatic hernias are defined as either congenital or acquired defect in the diaphragm
  • Congenital diaphragmatic hernia divided into 1) Bochdalek hernia-The most common type of diaphragmatic hernia (95%), located posterolaterally and usually present in infancy and 2) Morgagni hernia- anterior, smaller and present later in life
  • Acquired hernias are 1) Traumatic diaphragmatic hernia 2) Hiatus hernia and 3) iatrogenic hernia
  • Based on the location of the defect seen in this case, this is most probably undiagnosed Bochdalek hernia
Author: radhianahassan